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Sample records for intracranial pressure

  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. Intracranial pressure monitoring (image)

    Science.gov (United States)

    Intracranial pressure monitoring is performed by inserting a catheter into the head with a sensing device to monitor the pressure around the brain. An increase in intracranial pressure can cause a decrease in blood flow to ...

  3. Intracranial pressure monitoring

    Science.gov (United States)

    ICP monitoring; CSF pressure monitoring ... There are 3 ways to monitor pressure in the skull (intracranial pressure). INTRAVENTRICULAR CATHETER The intraventricular catheter is the most accurate monitoring method. To insert an intraventricular catheter, a ...

  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. 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

  6. Intracranial pressure after subarachnoid hemorrhage.

    Science.gov (United States)

    Zoerle, Tommaso; Lombardo, Alessandra; Colombo, Angelo; Longhi, Luca; Zanier, Elisa R; Rampini, Paolo; Stocchetti, Nino

    2015-01-01

    To describe mean intracranial pressure after aneurysmal subarachnoid hemorrhage, to identify clinical factors associated with increased mean intracranial pressure, and to explore the relationship between mean intracranial pressure and outcome. Analysis of a prospectively collected observational database. Neuroscience ICU of an academic hospital. One hundred sixteen patients with subarachnoid hemorrhage and intracranial pressure monitoring. None. Episodes of intracranial pressure greater than 20 mm Hg lasting at least 5 minutes and the mean intracranial pressure for every 12-hour interval were analyzed. The highest mean intracranial pressure was analyzed in relation to demographic characteristics, acute neurologic status, initial radiological findings, aneurysm treatment, clinical vasospasm, and ischemic lesion. Mortality and 6-month outcome (evaluated using a dichotomized Glasgow Outcome Scale) were also introduced in multivariable logistic models. Eighty-one percent of patients had at least one episode of high intracranial pressure and 36% had a highest mean intracranial pressure more than 20 mm Hg. The number of patients with high intracranial pressure peaked 3 days after subarachnoid hemorrhage and declined after day 7. Highest mean intracranial pressure greater than 20 mm Hg was significantly associated with initial neurologic status, aneurysmal rebleeding, amount of blood on CT scan, and ischemic lesion within 72 hours from subarachnoid hemorrhage. Patients with highest mean intracranial pressure greater than 20 mm Hg had significantly higher mortality. When death, vegetative state, and severe disability at 6 months were pooled, however, intracranial pressure was not an independent predictor of unfavorable outcome. High intracranial pressure is a common complication in the first week after subarachnoid hemorrhage in severe cases admitted to ICU. Mean intracranial pressure is associated with the severity of early brain injury and with mortality.

  7. 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...... standard in terms of accurate measurement of pressure, although microtransducers generally are just as accurate. Both invasive techniques are associated with a minor risk of complications such as hemorrhage and infection. Furthermore, zero drift is a problem with selected microtransducers. The non...

  8. INTRACRANIAL PRESSURE MONITORING

    Directory of Open Access Journals (Sweden)

    Retno Widiyanthi

    2013-07-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE Intracranial pressure is total of pressure that is produced by brain, blood, and cerebrospinal fluid/CSF in the tight cranial space. As a respon to intracranial pressure increasing, compensation begin by movement of CSF from ventricle to cerebral subarachnoidal space, and increase the absorption of CSF. Increasing of ICP usually caused by increasing of brain volume (cerebral oedem, blood (intracranial bleeding, space occupying lesion, or CSF (hidrocephalus. Indication in ICP monitoring can be seen from : neurological criteria, abnormal CT-scan result when admission, normal CT-scan result, but had more two risk factors. According to the procedure that must be done, there are two methods in ICP monitoring: invasive ICP monitoring methodes and non-invasive measuring method. Increasing of ICP will decrease the compliance of brain, pulsation of artery more clearly, and the component of vein is lost. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  9. Imaging of Intracranial Pressure Disorders.

    Science.gov (United States)

    Holbrook, John; Saindane, Amit M

    2017-03-01

    Intracranial pressure (ICP) is the pressure inside the bony calvarium and can be affected by a variety of processes, such as intracranial masses and edema, obstruction or leakage of cerebrospinal fluid, and obstruction of venous outflow. This review focuses on the imaging of 2 important but less well understood ICP disorders: idiopathic intracranial hypertension and spontaneous intracranial hypotension. Both of these ICP disorders have salient imaging findings that are important to recognize to help prevent their misdiagnosis from other common neurological disorders. Copyright © 2017 by the Congress of Neurological Surgeons.

  10. Critical cerebral perfusion pressure at high intracranial pressure measured by induced cerebrovascular and intracranial pressure reactivity.

    Science.gov (United States)

    Bragin, Denis E; Statom, Gloria L; Yonas, Howard; Dai, Xingping; Nemoto, Edwin M

    2014-12-01

    The lower limit of cerebral blood flow autoregulation is the critical cerebral perfusion pressure at which cerebral blood flow begins to fall. It is important that cerebral perfusion pressure be maintained above this level to ensure adequate cerebral blood flow, especially in patients with high intracranial pressure. However, the critical cerebral perfusion pressure of 50 mm Hg, obtained by decreasing mean arterial pressure, differs from the value of 30 mm Hg, obtained by increasing intracranial pressure, which we previously showed was due to microvascular shunt flow maintenance of a falsely high cerebral blood flow. The present study shows that the critical cerebral perfusion pressure, measured by increasing intracranial pressure to decrease cerebral perfusion pressure, is inaccurate but accurately determined by dopamine-induced dynamic intracranial pressure reactivity and cerebrovascular reactivity. Cerebral perfusion pressure was decreased either by increasing intracranial pressure or decreasing mean arterial pressure and the critical cerebral perfusion pressure by both methods compared. Cortical Doppler flux, intracranial pressure, and mean arterial pressure were monitored throughout the study. At each cerebral perfusion pressure, we measured microvascular RBC flow velocity, blood-brain barrier integrity (transcapillary dye extravasation), and tissue oxygenation (reduced nicotinamide adenine dinucleotide) in the cerebral cortex of rats using in vivo two-photon laser scanning microscopy. University laboratory. Male Sprague-Dawley rats. At each cerebral perfusion pressure, dopamine-induced arterial pressure transients (~10 mm Hg, ~45 s duration) were used to measure induced intracranial pressure reactivity (Δ intracranial pressure/Δ mean arterial pressure) and induced cerebrovascular reactivity (Δ cerebral blood flow/Δ mean arterial pressure). At a normal cerebral perfusion pressure of 70 mm Hg, 10 mm Hg mean arterial pressure pulses had no effect on

  11. Hypertensive response to raised intracranial pressure in infancy.

    OpenAIRE

    Kaiser, A M; Whitelaw, A G

    1988-01-01

    Mean arterial pressure and intracranial pressure were measured serially in six infants with intracranial hypertension (intracranial pressure greater than 20 mm Hg), and cerebral perfusion pressure was calculated from their difference. Overall, mean arterial pressure increased with rising intracranial pressure at a mean rate of 0.20 mm Hg/mm Hg. This caused a fall in cerebral perfusion pressure with increasing intracranial pressure at a mean rate of 0.80 mm Hg/mm Hg overall, although cerebral ...

  12. 21 CFR 882.1620 - Intracranial pressure monitoring device.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Intracranial pressure monitoring device. 882.1620... pressure monitoring device. (a) Identification. An intracranial pressure monitoring device is a device used for short-term monitoring and recording of intracranial pressures and pressure trends. The device...

  13. The Intracranial Volume Pressure Response in Increased Intracranial Pressure Patients: Clinical Significance of the Volume Pressure Indicator.

    Science.gov (United States)

    Lai, Hung-Yi; Lee, Ching-Hsin; Lee, Ching-Yi

    2016-01-01

    For patients suffering from primary brain injury, monitoring intracranial pressure alone is not enough to reflect the dynamic intracranial condition. In our previous study, a segment of the pressure-volume curve can be expressed by the parabolic regression model with single indicator "a". The aim of this study is to evaluate if the indicator "a" can reflect intracranial conditions. Patients with traumatic brain injury, spontaneous intracranial hemorrhage, and/or hydrocephalus who had external ventricular drainage from January 2009 to February 2010 were included. The successive volume pressure response values were obtained by successive drainage of cerebral spinal fluid from intracranial pressure 20-25 mm Hg to 10 mm Hg. The relationship between withdrawn cerebral spinal fluid volume and intracranial pressure was analyzed by the parabolic regression model with single parameter "a". The overall mean for indicator "a" was 0.422 ± 0.046. The mean of "a" in hydrocephalus was 0.173 ± 0.024 and in severe intracranial mass with slender ventricle, it was 0.663 ± 0.062. The two extreme intracranial conditions had a statistical significant difference (ppressure-volume curve can reflect the dynamic intracranial condition and is comparable in different situations. A significantly larger indicator "a" with increased intracranial pressure is always observed in severe intracranial mass lesions with cerebral edema. A significantly smaller indicator "a" with increased intracranial pressure is observed in hydrocephalus. Brain computed tomography should be performed early if a rapid elevation of indicator "a" is detected, as it can reveal some ongoing intracranial pathology prior to clinical deterioration. Increased intracranial pressure was frequently observed in patients with intracranial pathology. The progression can be differentiated using the pattern of the volume pressure indicator.

  14. Measuring elevated intracranial pressure through noninvasive methods

    DEFF Research Database (Denmark)

    Kristiansson, Helena; Nissborg, Emelie; Bartek, Jiri

    2013-01-01

    Elevated intracranial pressure (ICP) is an important cause of secondary brain injury, and a measurement of ICP is often of crucial value in neurosurgical and neurological patients. The gold standard for ICP monitoring is through an intraventricular catheter, but this invasive technique...

  15. Lumbar puncture opening pressure is not a reliable measure of intracranial pressure in children.

    Science.gov (United States)

    Cartwright, Cathy; Igbaseimokumo, Usiakimi

    2015-02-01

    There is very little data correlating lumbar puncture pressures to formal intracranial pressure monitoring despite the widespread use of both procedures. The hypothesis was that lumbar puncture is a single-point measurement and hence it may not be a reliable evaluation of intracranial pressure. The study was therefore carried out to compare lumbar puncture opening pressures with the Camino bolt intracranial pressure monitor in children. Twelve children with a mean age of 8.5 years who had both lumbar puncture and intracranial pressure monitoring were analyzed. The mean lumbar puncture opening pressure was 22.4 mm Hg versus a mean Camino bolt intracranial pressure of 7.8 mm Hg (P intracranial pressure in children. There were no complications from the intracranial pressure monitoring, and the procedure changed the treatment of all 12 children avoiding invasive operative procedures in most of the patients. © The Author(s) 2014.

  16. Intracranial pressure changes during mouse development.

    Science.gov (United States)

    Moazen, Mehran; Alazmani, Ali; Rafferty, Katherine; Liu, Zi-Jun; Gustafson, Jennifer; Cunningham, Michael L; Fagan, Michael J; Herring, Susan W

    2016-01-04

    During early stages of postnatal development, pressure from the growing brain as well as cerebrospinal fluid, i.e. intracranial pressure (ICP), load the calvarial bones. It is likely that such loading contributes to the peripheral bone formation at the sutural edges of calvarial bones, especially shortly after birth when the brain is growing rapidly. The aim of this study was to quantify ICP during mouse development. A custom pressure monitoring system was developed and calibrated. It was then used to measure ICP in a total of seventy three wild type mice at postnatal (P) day 3, 10, 20, 31 and 70. Retrospectively, the sample in each age group with the closest ICP to the average value was scanned using micro-computed tomography to estimate cranial growth. ICP increased from 1.33±0.87mmHg at P3 to 1.92±0.78mmHg at P10 and 3.60±1.08mmHg at P20. In older animals, ICP plateaued at about 4mmHg. There were statistically significant differences between the ICP at the P3 vs. P20, and P10 vs. P20. In the samples that were scanned, intracranial volume and skull length followed a similar pattern of increase up to P20 and then plateaued at older ages. These data are consistent with the possibility of ICP being a contributing factor to bone formation at the sutures during early stages of development. The data can be further used for development and validation of computational models of skull growth. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. 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.

  18. 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

  19. 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.

  20. 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.

  1. Management of raised intracranial pressure and hyperosmolar therapy.

    Science.gov (United States)

    Ropper, Allan H

    2014-06-01

    The management of raised intracranial pressure is undergoing rapid change. The choice of medical treatments to reduce intracranial pressure varies between institutions and regions of the world. The mainstay of therapy, however, continues to be the infusion of a hyperosmolar solution to achieve an osmotic gradient to force the exit of water from the brain. This review introduces the basic concepts of raised intracranial pressure, summarises several recent studies that have challenged dogma in the field, and provides practical advice on hyperosmolar treatment, based on personal experience and a critical reading of the literature.

  2. High Intracranial Pressure Induced Injury in the Healthy Rat Brain.

    Science.gov (United States)

    Dai, Xingping; Bragina, Olga; Zhang, Tongsheng; Yang, Yirong; Rao, Gutti R; Bragin, Denis E; Statom, Gloria; Nemoto, Edwin M

    2016-08-01

    We recently showed that increased intracranial pressure to 50 mm Hg in the healthy rat brain results in microvascular shunt flow characterized by tissue hypoxia, edema, and increased blood-brain barrier permeability. We now determined whether increased intracranial pressure results in neuronal injury by Fluoro-Jade stain and whether changes in cerebral blood flow and cerebral metabolic rate for oxygen suggest nonnutritive microvascular shunt flow. Intracranial pressure was elevated by a reservoir of artificial cerebrospinal fluid connected to the cisterna magna. Arterial blood gases, cerebral arterial-venous oxygen content difference, and cerebral blood flow by MRI were measured. Fluoro-Jade stain neurons were counted in histologic sections of the right and left dorsal and lateral cortices and hippocampus. University laboratory. Male Sprague Dawley rats. Arterial pressure support if needed by IV dopamine infusion and base deficit corrected by sodium bicarbonate. Fluoro-Jade stain neurons increased 2.5- and 5.5-fold at intracranial pressures of 30 and 50 mm Hg and cerebral perfusion pressures of 57 ± 4 (mean ± SEM) and 47 ± 6 mm Hg, respectively (p intracranial pressure and decreased cerebral metabolic rate for oxygen. High intracranial pressure likely caused neuronal injury because of a transition from normal capillary flow to nonnutritive microvascular shunt flow resulting in tissue hypoxia and edema, and it is manifest by a reduction in the cerebral metabolic rate for oxygen.

  3. Imaging Modalities Relevant to Intracranial Pressure Assessment in Astronauts

    Science.gov (United States)

    Sargsyan, Ashot E.; Kramer, Larry A.; Hamilton, Douglas R.; Fogarty, Jennifer; Polk, J. D.

    2011-01-01

    Learning Objectives of this slide presentation are: 1: To review the morphological changes in orbit structures caused by elevated Intracranial Pressure (ICP), and their imaging representation. 2: To learn about the similarities and differences between MRI and sonographic imaging of the eye and orbit. 3: To learn about the role of MRI and sonography in the noninvasive assessment of intracranial pressure in aerospace medicine, and the added benefits from their combined interpretation.

  4. Prediction of intracranial hypertension through noninvasive intracranial pressure waveform analysis in pediatric hydrocephalus.

    Science.gov (United States)

    Ballestero, Matheus Fernando Manzolli; Frigieri, Gustavo; Cabella, Brenno Caetano Troca; de Oliveira, Sergio Mascarenhas; de Oliveira, Ricardo Santos

    2017-09-01

    The purpose of this study is to evaluate a noninvasive device to assess intracranial pressure wave form in children with hydrocephalus. A prospective and non-experimental descriptive-analytic study was performed. Fifty-six patients were enrolled in this study. They were divided in four groups: group A, children with clinically compensated hydrocephalus; B, surgically treated hydrocephalus; C, patients with acute intracranial hypertension due to hydrocephalus; and D, children without neurological disease (control). Data were collected through the installation of an extracranial deformation sensor, coupled to the children's scalp, which allowed registration of noninvasive intracranial pressure curves. Parameters obtained were analyzed: P2/P1 ratio, "classification P1 and P2 and P1 slope. P2/P1 index and "classification of P1 and P2" had a sensitivity of 80% and specificity of 100% for predicting intracranial hypertension. "P1 slope" presented no statistical difference. This study showed a useful and noninvasive method for monitoring intracranial pressure, which was able to indicate the intracranial hypertension in children with hydrocephalus and, thus, should be further investigated for clinical applications.

  5. Pulsatile Intracranial Pressure and Cerebral Autoregulation After Traumatic Brain Injury

    NARCIS (Netherlands)

    Radolovich, D. K.; Aries, M.J.H.; Castellani, G.; Corona, A.; Lavinio, A.; Smielewski, P.; Pickard, J. D.; Czosnyka, M.

    2011-01-01

    Strong correlation between mean intracranial pressure (ICP) and its pulse wave amplitude (AMP) has been demonstrated in different clinical scenarios. We investigated the relationship between invasive mean arterial blood pressure (ABP) and AMP to explore its potential role as a descriptor of

  6. Effect of abdominal insufflation for laparoscopy on intracranial pressure.

    Science.gov (United States)

    Kamine, Tovy Haber; Papavassiliou, Efstathios; Schneider, Benjamin E

    2014-04-01

    Increased abdominal pressure may have a negative effect on intracranial pressure (ICP). Human data on the effects of laparoscopy on ICP are lacking. We retrospectively reviewed laparoscopic operations for ventriculoperitoneal shunt placement to determine the effect of insufflation on ICP. Nine patients underwent insufflation with carbon dioxide (CO(2)) at pressures ranging from 8 to 15 mm Hg and ICP measured through a ventricular catheter. We used a paired t test to compare ICP with insufflation and desufflation. Linear regression correlated insufflation pressure with ICP. The mean ICP increase with 15-mm Hg insufflation is 7.2 (95% CI, 5.4-9.1 [P pressure (P = .04). Maximum ICP recorded was 25 cm H(2)O. Intracranial pressure significantly increases with abdominal insufflation and correlates with laparoscopic insufflation pressure. The maximum ICP measured was a potentially dangerous 25 cm H(2)O. Laparoscopy should be used cautiously in patients with a baseline elevated ICP or head trauma.

  7. 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....... The diagnostic ability of OCT as a marker of increased ICP (> 25 cmH(2)O) was investigated using multiple regression and receiver operating characteristic (ROC) curves. RESULTS: OCT elevation diagrams showed that in 60 % of patients newly diagnosed with IIH and in 10 % of patients with long-term IIH, 50...

  8. Idiopathic Intracranial Hypertension in Monozygotic Female Twins: Intracranial Pressure Dynamics and Treatment Outcome.

    Science.gov (United States)

    Polemikos, Manolis; Heissler, Hans E; Hermann, Elvis J; Krauss, Joachim K

    2017-05-01

    Familial cases of idiopathic intracranial hypertension (IIH) are exceedingly rare, and its occurrence in monozygotic twins has not been reported previously. We report monozygotic female twins who developed IIH, one at age 25 years and the other at age 28 years. Continuous intracranial pressure (ICP) monitoring confirmed elevated ICP as measured initially by lumbar puncture. In both cases, successful treatment with resolution of papilledema and symptoms relief was achieved after ventriculoperitoneal shunting. This report documents the first case of IIH in monozygotic twins and the associated changes in ICP dynamics. Interestingly, almost equivalent alterations in ICP dynamics were found in the 2 patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Utility of Intracranial Pressure Monitoring for Diagnosis of Idiopathic Intracranial Hypertension in the Absence of Papilledema.

    Science.gov (United States)

    Bridges, Kelly J; Raslan, Ahmed M

    2018-03-01

    Idiopathic intracranial hypertension (IIH) is characterized by headaches, visual obscurations, and papilledema, and the diagnosis involves lumbar puncture (LP) with an elevated opening pressure (OP) ≥20 cm H 2 0. When papilledema is absent, the diagnosis becomes less clear. Some physicians have argued that the absence of papilledema rules out IIH, whereas others maintain that elevated OP is sufficient for diagnosis. The authors performed a single-institution 4-year retrospective analysis of patients who underwent invasive intracranial pressure (ICP) monitoring for presumed IIH. A total of 22 patients were reviewed, and 13 had classic symptoms of IIH, documented elevated OP, and absence of papilledema; 5/13 (38%) patients had proven intracranial hypertension as shown by invasive ICP monitoring, whereas 8/13 (62%) had normal ICP. With the use of current diagnostic algorithms of clinical presentation and elevated OP, over half of patients without papilledema in our series would be falsely diagnosed with IIH, which could result in unnecessary medical and surgical intervention. Thus, elevated OP as determined by LP is insufficient to diagnose IIH. On the other hand, the absence of papilledema does not rule out intracranial hypertension. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Deformation of skull bone as intracranial pressure changing | Yue ...

    African Journals Online (AJOL)

    By using the 'Ansys' finite element processor, a three-dimensional FEM of a hollow sphere was constructed for human skull. The model was used to calculate the deformation of human skull with the intracranial pressure changing. The skull is a layered sphere constructed in a specially designed form with a Tabula externa, ...

  11. Deformation of skull bone as intracranial pressure changing

    African Journals Online (AJOL)

    STORAGESEVER

    2009-03-06

    Mar 6, 2009 ... The cranium could move and human skull - dura mater system was deformed as the ICP fluctuates. Key words: Deformation, skull bone, intracranial pressure, finite-element model, rat. ..... A silicone rubber cylinder attached to a nylon surgical thread was inserted through the internal carotid artery in rats and ...

  12. The correlation between pulsatile intracranial pressure and indices of intracranial pressure-volume reserve capacity: results from ventricular infusion testing.

    Science.gov (United States)

    Eide, Per Kristian

    2016-12-01

    OBJECTIVE The objective of this study was to examine how pulsatile and static intracranial pressure (ICP) scores correlate with indices of intracranial pressure-volume reserve capacity, i.e., intracranial elastance (ICE) and intracranial compliance (ICC), as determined during ventricular infusion testing. METHODS All patients undergoing ventricular infusion testing and overnight ICP monitoring during the 6-year period from 2007 to 2012 were included in the study. Clinical data were retrieved from a quality registry, and the ventricular infusion pressure data and ICP scores were retrieved from a pressure database. The ICE and ICC (= 1/ICE) were computed during the infusion phase of the infusion test. RESULTS During the period from 2007 to 2012, 82 patients with possible treatment-dependent hydrocephalus underwent ventricular infusion testing within the department of neurosurgery. The infusion tests revealed a highly significant positive correlation between ICE and the pulsatile ICP scores mean wave amplitude (MWA) and rise-time coefficient (RTC), and the static ICP score mean ICP. The ICE was negatively associated with linear measures of ventricular size. The overnight ICP recordings revealed significantly increased MWA (> 4 mm Hg) and RTC (> 20 mm Hg/sec) values in patients with impaired ICC ( 4 mm Hg, RTC > 20 mm Hg/sec), but not increased mean ICP (pressure-volume reserve capacity, i.e., ICE and ICC.

  13. Monitoring of Intracranial Pressure in Patients with Traumatic Brain Injury

    Science.gov (United States)

    Hawthorne, Christopher; Piper, Ian

    2014-01-01

    Since Monro published his observations on the nature of the contents of the intracranial space in 1783, there has been investigation of the unique relationship between the contents of the skull and the intracranial pressure (ICP). This is particularly true following traumatic brain injury (TBI), where it is clear that elevated ICP due to the underlying pathological processes is associated with a poorer clinical outcome. Consequently, there is considerable interest in monitoring and manipulating ICP in patients with TBI. The two techniques most commonly used in clinical practice to monitor ICP are via an intraventricular or intraparenchymal catheter with a microtransducer system. Both of these techniques are invasive and are thus associated with complications such as hemorrhage and infection. For this reason, significant research effort has been directed toward development of a non-invasive method to measure ICP. The principle aims of ICP monitoring in TBI are to allow early detection of secondary hemorrhage and to guide therapies that limit intracranial hypertension (ICH) and optimize cerebral perfusion. However, information from the ICP value and the ICP waveform can also be used to assess the intracranial volume–pressure relationship, estimate cerebrovascular pressure reactivity, and attempt to forecast future episodes of ICH. PMID:25076934

  14. Intracranial Pressure Is a Determinant of Sympathetic Activity

    OpenAIRE

    Eric A. Schmidt; Eric A. Schmidt; Fabien Despas; Fabien Despas; Anne Pavy-Le Traon; Anne Pavy-Le Traon; Zofia Czosnyka; John D. Pickard; Kamal Rahmouni; Atul Pathak; Atul Pathak; Jean M. Senard; Jean M. Senard

    2018-01-01

    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 arteria...

  15. 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.

  16. Noninvasive intracranial pressure monitoring for HIV-associated cryptococcal meningitis

    Directory of Open Access Journals (Sweden)

    V.R. Bollela

    Full Text Available Mortality and adverse neurologic sequelae from HIV-associated cryptococcal meningitis (HIV-CM remains high due to raised intracranial pressure (ICP complications. Cerebrospinal fluid (CSF high opening pressure occurs in more than 50% of HIV-CM patients. Repeated lumbar puncture with CSF drainage and external lumbar drainage might be required in the management of these patients. Usually, there is a high grade of uncertainty and the basis for clinical decisions regarding ICP hypertension tends to be from clinical findings (headache, nausea and vomiting, a low Glasgow coma scale score, and/or fundoscopic papilledema. Significant neurological decline can occur if elevated CSF pressures are inadequately managed. Various treatment strategies to address intracranial hypertension in this setting have been described, including: medical management, serial lumbar punctures, external lumbar and ventricular drain placement, and either ventricular or lumbar shunting. This study aims to evaluate the role of a non-invasive intracranial pressure (ICP-NI monitoring in a critically ill HIV-CM patient.

  17. Noninvasive intracranial pressure monitoring for HIV-associated cryptococcal meningitis.

    Science.gov (United States)

    Bollela, V R; Frigieri, G; Vilar, F C; Spavieri, D L; Tallarico, F J; Tallarico, G M; Andrade, R A P; de Haes, T M; Takayanagui, O M; Catai, A M; Mascarenhas, S

    2017-08-07

    Mortality and adverse neurologic sequelae from HIV-associated cryptococcal meningitis (HIV-CM) remains high due to raised intracranial pressure (ICP) complications. Cerebrospinal fluid (CSF) high opening pressure occurs in more than 50% of HIV-CM patients. Repeated lumbar puncture with CSF drainage and external lumbar drainage might be required in the management of these patients. Usually, there is a high grade of uncertainty and the basis for clinical decisions regarding ICP hypertension tends to be from clinical findings (headache, nausea and vomiting), a low Glasgow coma scale score, and/or fundoscopic papilledema. Significant neurological decline can occur if elevated CSF pressures are inadequately managed. Various treatment strategies to address intracranial hypertension in this setting have been described, including: medical management, serial lumbar punctures, external lumbar and ventricular drain placement, and either ventricular or lumbar shunting. This study aims to evaluate the role of a non-invasive intracranial pressure (ICP-NI) monitoring in a critically ill HIV-CM patient.

  18. Bedside Optic Nerve Sheath Diameter Assessment in the Identification of Increased Intracranial Pressure in Suspected Idiopathic Intracranial Hypertension.

    Science.gov (United States)

    Irazuzta, Jose E; Brown, Martha E; Akhtar, Javed

    2016-01-01

    We determined whether the bedside assessment of the optic nerve sheath diameter could identify elevated intracranial pressure in individuals with suspected idiopathic intracranial hypertension. This was a single-center, prospective, rater-blinded study performed in a freestanding pediatric teaching hospital. Patients aged 12 to 18 years scheduled for an elective lumbar puncture with the suspicion of idiopathic intracranial hypertension were eligible to participate. Optic nerve sheath diameter was measured via ultrasonography before performing a sedated lumbar puncture for measuring cerebrospinal fluid opening pressure. Abnormal measurements were predefined as optic nerve sheath diameter ≥4.5 mm and a cerebrospinal fluid opening pressure greater than 20 cmH2O. Thirteen patients participated in the study, 10 of whom had elevated intracranial pressure. Optic nerve sheath diameter was able to predict or rule out elevated intracranial pressure in all patients. Noninvasive assessment of the optic nerve sheath diameter could help to identify patients with elevated intracranial pressure when idiopathic intracranial hypertension is suspected. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Visualizing the pressure and time burden of intracranial hypertension in adult and paediatric traumatic brain injury.

    Science.gov (United States)

    Güiza, Fabian; Depreitere, Bart; Piper, Ian; Citerio, Giuseppe; Chambers, Iain; Jones, Patricia A; Lo, Tsz-Yan Milly; Enblad, Per; Nillson, Pelle; Feyen, Bart; Jorens, Philippe; Maas, Andrew; Schuhmann, Martin U; Donald, Rob; Moss, Laura; Van den Berghe, Greet; Meyfroidt, Geert

    2015-06-01

    To assess the impact of the duration and intensity of episodes of increased intracranial pressure on 6-month neurological outcome in adult and paediatric traumatic brain injury. Analysis of prospectively collected minute-by-minute intracranial pressure and mean arterial blood pressure data of 261 adult and 99 paediatric traumatic brain injury patients from multiple European centres. The relationship of episodes of elevated intracranial pressure (defined as a pressure above a certain threshold during a certain time) with 6-month Glasgow Outcome Scale was visualized in a colour-coded plot. The colour-coded plot illustrates the intuitive concept that episodes of higher intracranial pressure can only be tolerated for shorter durations: the curve that delineates the duration and intensity of those intracranial pressure episodes associated with worse outcome is an approximately exponential decay curve. In children, the curve resembles that of adults, but the delineation between episodes associated with worse outcome occurs at lower intracranial pressure thresholds. Intracranial pressures above 20 mmHg lasting longer than 37 min in adults, and longer than 8 min in children, are associated with worse outcomes. In a multivariate model, together with known baseline risk factors for outcome in severe traumatic brain injury, the cumulative intracranial pressure-time burden is independently associated with mortality. When cerebrovascular autoregulation, assessed with the low-frequency autoregulation index, is impaired, the ability to tolerate elevated intracranial pressures is reduced. When the cerebral perfusion pressure is below 50 mmHg, all intracranial pressure insults, regardless of duration, are associated with worse outcome. The intracranial pressure-time burden associated with worse outcome is visualised in a colour-coded plot. In children, secondary injury occurs at lower intracranial pressure thresholds as compared to adults. Impaired cerebrovascular

  20. Dynamic Cerebrovascular and Intracranial Pressure Reactivity Assessment of Impaired Cerebrovascular Autoregulation in Intracranial Hypertension.

    Science.gov (United States)

    Bragin, Denis E; Statom, Gloria; Nemoto, Edwin M

    2016-01-01

    We previously suggested that the discrepancy between a critical cerebral perfusion pressure (CPP) of 30 mmHg, obtained by increasing intracranial pressure (ICP), and 60 mmHg, obtained by decreasing arterial pressure, was due to pathological microvascular shunting at high ICP [1], and that the determination of the critical CPP by the static cerebral blood flow (CBF) autoregulation curve is not valid with intracranial hypertension. Here, we demonstrated that induced dynamic ICP reactivity (iPRx), and cerebrovascular reactivity (CVRx) tests accurately identify the critical CPP in the hypertensive rat brain, which differs from that obtained by the static autoregulation curve. Step changes in CPP from 70 to 50 and 30 mmHg were made by increasing ICP using an artificial cerebrospinal fluid reservoir connected to the cisterna magna. At each CPP, a transient 10-mmHg increase in arterial pressure was induced by bolus intravenous dopamine. iPRx and iCVRx were calculated as ΔICP/Δ mean arterial pressure (MAP) and as ΔCBF/ΔMAP, respectively. The critical CPP at high ICP, obtained by iPRx and iCVRx, is 50 mmHg, where compromised capillary flow, transition of blood flow to nonnutritive microvascular shunts, tissue hypoxia, and brain-blood barrier leakage begin to occur, which is higher than the 30 mmHg determined by static autoregulation.

  1. 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....

  2. Pathogenesis of optic disc edema in raised intracranial pressure.

    Science.gov (United States)

    Hayreh, Sohan Singh

    2016-01-01

    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

  3. Noninvasive assessment of intracranial elastance and pressure in spontaneous intracranial hypotension by MRI.

    Science.gov (United States)

    Tsai, Yi-Hsin; Chen, Hung-Chieh; Tung, Hsin; Wu, Yi-Ying; Chen, Hsian-Min; Pan, Kuan-Jung; Cheng, Da-Chuan; Chen, Jeon-Hor; Chen, Clayton Chi-Chang; Chai, Jyh-Wen; Shen, Wu-Chung

    2018-02-13

    Spontaneous intracranial hypotension (SIH) is often misdiagnosed, and can lead to severe complications. Conventional MR sequences show a limited ability to aid in this diagnosis. MR-based intracranial pressure (MR-ICP) may be able to detect changes of intracranial elastance and pressure. To determine whether MR-ICP is able to differentiate SIH patients from normal subjects, improve diagnostic sensitivity, and provide an insight into the pathophysiology. Prospective. Twenty-eight SIH cases with orthostatic headache and 20 healthy volunteers. Cine phase-contrast MRI on a 1.5T scanner. Intracranial elastance (IE) was derived from the ratio of the peak-to-peak cerebrospinal fluid (CSF) pressure gradient (PG csf-pp ) and intracranial volume change, obtained by summing all flows before each sequential cardiac frame. Student's t-test was used to compare the MR-ICP indexes and flow parameters between SIH patients and healthy volunteers (P < 0.01). The SIH patients with cervical epidural venous dilatation (EVD) had an IE of 0.121 ± 0.027 mmHg/cm/ml, significantly higher than that of the normal volunteers (0.085 ± 0.027 mmHg/cm/ml; P = 0.002). In contradistinction, the EVD-negative SIH patients, including four with no sign of CSF leaks, had significantly lower IE (0.055 ± 0.012 mmHg/cm/ml) compared with the normal volunteers and the EVD-positive group (P = 0.001, P < 0.001). The EVD-negative patients had significantly lower PG csf-pp (0.024 ± 0.007 mmHg/cm) compared with the normal volunteers and the EVD-positive group (0.035 ± 0.011 mmHg/cm, 0.040 ± 0.010 mmHg/cm; P = 0.003, P < 0.001). Additionally, the MRI flow study showed a significant decrease in transcranial inflow and outflow of SIH patients (P < 0.01). We found that the MR-ICP method is potentially more sensitive than morphological MRI in the early diagnosis of SIH. Also, contrary to common belief, our results suggest that an abnormal craniospinal elastance

  4. Complexity of intracranial pressure correlates with outcome after traumatic brain injury

    Science.gov (United States)

    Lu, Cheng-Wei; Czosnyka, Marek; Shieh, Jiann-Shing; Smielewska, Anna; Pickard, John D.

    2012-01-01

    This study applied multiscale entropy analysis to investigate the correlation between the complexity of intracranial pressure waveform and outcome after traumatic brain injury. Intracranial pressure and arterial blood pressure waveforms were low-pass filtered to remove the respiratory and pulse components and then processed using a multiscale entropy algorithm to produce a complexity index. We identified significant differences across groups classified by the Glasgow Outcome Scale in intracranial pressure, pressure-reactivity index and complexity index of intracranial pressure (P intracranial pressure achieved the strongest statistical significance (F = 28.7; P intracranial pressure assessed by multiscale entropy was significantly associated with outcome in patients with brain injury. PMID:22734128

  5. Increased Intracranial Pressure in the Setting ofEnterovirusand Other Viral Meningitides.

    Science.gov (United States)

    Beal, Jules C

    2017-01-01

    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.

  6. 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.

  7. Effect of gravity and microgravity on intracranial pressure.

    Science.gov (United States)

    Lawley, Justin S; Petersen, Lonnie G; Howden, Erin J; Sarma, Satyam; Cornwell, William K; Zhang, Rong; Whitworth, Louis A; Williams, Michael A; Levine, Benjamin D

    2017-03-15

    Astronauts have recently been discovered to have impaired vision, with a presentation that resembles syndromes of elevated intracranial pressure on Earth. Gravity has a profound effect on fluid distribution and pressure within the human circulation. In contrast to prevailing theory, we observed that microgravity reduces central venous and intracranial pressure. This being said, intracranial pressure is not reduced to the levels observed in the 90 deg seated upright posture on Earth. Thus, over 24 h in zero gravity, pressure in the brain is slightly above that observed on Earth, which may explain remodelling of the eye in astronauts. Astronauts have recently been discovered to have impaired vision, with a presentation that resembles syndromes of elevated intracranial pressure (ICP). This syndrome is considered the most mission-critical medical problem identified in the past decade of manned spaceflight. We recruited five men and three women who had an Ommaya reservoir inserted for the delivery of prophylactic CNS chemotherapy, but were free of their malignant disease for at least 1 year. ICP was assessed by placing a fluid-filled 25 gauge butterfly needle into the Ommaya reservoir. Subjects were studied in the upright and supine position, during acute zero gravity (parabolic flight) and prolonged simulated microgravity (6 deg head-down tilt bedrest). ICP was lower when seated in the 90 deg upright posture compared to lying supine (seated, 4 ± 1 vs. supine, 15 ± 2 mmHg). Whilst lying in the supine posture, central venous pressure (supine, 7 ± 3 vs. microgravity, 4 ± 2 mmHg) and ICP (supine, 17 ± 2 vs. microgravity, 13 ± 2 mmHg) were reduced in acute zero gravity, although not to the levels observed in the 90 deg seated upright posture on Earth. Prolonged periods of simulated microgravity did not cause progressive elevations in ICP (supine, 15 ± 2 vs. 24 h head-down tilt, 15 ± 4 mmHg). Complete removal of gravity does not

  8. The major influence of the atmosphere on intracranial pressure: an observational study.

    Science.gov (United States)

    Herbowski, Leszek

    2017-01-01

    The impact of the atmosphere on human physiology has been studied widely within the last years. In practice, intracranial pressure is a pressure difference between intracranial compartments and the surrounding atmosphere. This means that gauge intracranial pressure uses atmospheric pressure as its zero point, and therefore, this method of pressure measurement excludes the effects of barometric pressure's fluctuation. The comparison of these two physical quantities can only take place through their absolute value relationship. The aim of this study is to investigate the direct effect of barometric pressure on the absolute intracranial pressure homeostasis. A prospective observational cross-sectional open study was conducted in Szczecin, Poland. In 28 neurosurgical patients with suspected normal-pressure hydrocephalus, intracranial intraventricular pressure was monitored in a sitting position. A total of 168 intracranial pressure and atmospheric pressure measurements were performed. Absolute atmospheric pressure was recorded directly. All values of intracranial gauge pressure were converted to absolute pressure (the sum of gauge intracranial pressure and local absolute atmospheric pressure). The average absolute mean intracranial pressure in the patients is 1006.6 hPa (95 % CI 1004.5 to 1008.8 hPa, SEM 1.1), and the mean absolute atmospheric pressure is 1007.9 hPa (95 % CI 1006.3 to 1009.6 hPa, SEM 0.8). The observed association between atmospheric and intracranial pressure is strongly significant (Spearman correlation r = 0.87, p impacted positively by atmospheric pressure.

  9. Relationship between intracranial pressure and phase contrast cine MRI derived measures of intracranial pulsations in idiopathic normal pressure hydrocephalus.

    Science.gov (United States)

    Jaeger, Matthias; Khoo, Angela K; Conforti, David A; Cuganesan, Ramesh

    2016-11-01

    Phase contrast cine MRI with determination of pulsatile aqueductal cerebrospinal fluid (CSF) stroke volume and flow velocity has been suggested to assess intracranial pulsations in idiopathic normal pressure hydrocephalus (iNPH). We aimed to compare this non-invasive measure of pulsations to intracranial pressure (ICP) pulse wave amplitude from continuous ICP monitoring. We hypothesised that a significant correlation between these two markers of intracranial pulsations exists. Fifteen patients with suspected iNPH had continuous computerised ICP monitoring with calculation of mean ICP pulse wave amplitude (MWA) from time-domain analysis. MRI measured CSF aqueductal stroke volume and peak flow velocity. Mean MWA was 5.4mmHg (range 2.3-12.4mmHg). Mean CSF stroke volume and peak flow velocity were 65μl (range 3-195μl) and 9.31cm/s (range 1.68-15.0cm/s), respectively. No significant correlation between the invasive and non-invasive measures of pulsations existed (Spearman r=-0.30 and r=-0.27, respectively; p>0.05). We observed marked intra-individual fluctuation of MWA during continuous ICP monitoring of an average of 6.0mmHg (range 2.8-12.2mmHg). The results suggest a complex interplay between measures of pulsations derived from snapshot MRI measurements and continuous computerised ICP measurements, as no significant relationship existed in our data. Further study is needed to better understand the temporal profile of CSF MRI flow studies, as substantial variation in MWA over the course of several hours of ICP monitoring is common, suggesting that these physiologic fluctuations might obscure MRI snapshot measures of intracranial pulsations. Copyright © 2016 Elsevier Ltd. All rights reserved.

  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. [Effects of solcoseryl on the cerebral blood flow, intracranial pressure, systemic blood pressure and EEG in acute intracranial hypertensive cats (author's transl)].

    Science.gov (United States)

    Kubota, S; Asakura, T; Kitamura, K

    1976-02-01

    The experiment was performed on 86 cases under intraperitoneal pentobarbital anesthesia. One balloon was placed in the extradural space of right frontal region, and the other balloon was placed in the left extradural space and the intracranial pressure was measured. A needle was stereotaxically inserted into the subcortical area in order to measure the cerebral blood flow. Systemic blood pressure was recorded by inserting a catheter into the femoral artery, and electrocorticogram was also recorded. An expanding intracranial lesion was made by inflating the extradural balloon with physiological saline. The animals were arbitrarily divided into two groups.: 1) light or moderate groups which intracranial pressure before the injection of drug was below 400 mmH2O. 2) severe groups above 400 mmH2O. After the maintenance of the pressure, Solcoseryl was infused intravenously. The investigation was focused to observe whether Solcoseryl reveales any potent effect on cerebral blood flow, intracranial pressure, systemic blood pressure and on electroencephalogram in acute intracranial hypertension. Results 1) Intravenous injection of Solcoseryl had the effect of lowering intracranial pressure in the light or moderate and severe groups. Particularly, dose of 80 mg/kg showed the marked effect, though with a rebound phenomenon in the light or moderate groups. Furthermore, the effect was more marked and lasting by drip infusion of Solcoseryl and also by intravenous injection of Solcoseryl after pretreatment with hydrocortisone, and at this time no rebound phenomenon was recognized. 2) Solcoseryl had the effect of increasing the cerebral blood flow accompained with the lowering of intracranial pressure. 3) Systemic blood pressure was transiently lowered by the injection of Solcoseryl 20 mg/kg or 80 mg/kg and recovered immediately. 4) Solcoseryl had no effect on electroencephalogram in the severe groups. Conclusion On the basis of these results, it is rational to conclude that

  12. Effect of venous stenting on intracranial pressure in idiopathic intracranial hypertension.

    Science.gov (United States)

    Matloob, Samir A; Toma, Ahmed K; Thompson, Simon D; Gan, Chee L; Robertson, Fergus; Thorne, Lewis; Watkins, Laurence D

    2017-08-01

    Idiopathic intracranial hypertension (IIH) is characterised by an increased intracranial pressure (ICP) in the absence of any central nervous system disease or structural abnormality and by normal CSF composition. Management becomes complicated once surgical intervention is required. Venous sinus stenosis has been suggested as a possible aetiology for IIH. Venous sinus stenting has emerged as a possible interventional option. Evidence for venous sinus stenting is based on elimination of the venous pressure gradient and clinical response. There have been no studies demonstrating the immediate effect of venous stenting on ICP. Patients with a potential or already known diagnosis of IIH were investigated according to departmental protocol. ICP monitoring was performed for 24 h. When high pressures were confirmed, CT venogram and catheter venography were performed to look for venous stenosis to demonstrate a pressure gradient. If positive, venous stenting would be performed and ICP monitoring would continue for a further 24 h after deployment of the venous stent. Ten patients underwent venous sinus stenting with concomitant ICP monitoring. Nine out of ten patients displayed an immediate reduction in their ICP that was maintained at 24 h. The average reduction in mean ICP and pulsatility was significant (p = 0.003). Six out of ten patients reported a symptomatic improvement within the first 2 weeks. Venous sinus stenting results in an immediate reduction in ICP. This physiological response to venous stenting has not previously been reported. Venous stenting could offer an alternative treatment option in correctly selected patients with IIH.

  13. Human neuronal changes in brain edema and increased intracranial pressure.

    Science.gov (United States)

    Faragó, Nóra; Kocsis, Ágnes Katalin; Braskó, Csilla; Lovas, Sándor; Rózsa, Márton; Baka, Judith; Kovács, Balázs; Mikite, Katalin; Szemenyei, Viktor; Molnár, Gábor; Ozsvár, Attila; Oláh, Gáspár; Piszár, Ildikó; Zvara, Ágnes; Patócs, Attila; Barzó, Pál; Puskás, László G; Tamás, Gábor

    2016-08-04

    Functional and molecular changes associated with pathophysiological conditions are relatively easily detected based on tissue samples collected from patients. Population specific cellular responses to disease might remain undiscovered in samples taken from organs formed by a multitude of cell types. This is particularly apparent in the human cerebral cortex composed of a yet undefined number of neuron types with a potentially different involvement in disease processes. We combined cellular electrophysiology, anatomy and single cell digital PCR in human neurons identified in situ for the first time to assess mRNA expression and corresponding functional changes in response to edema and increased intracranial pressure. In single pyramidal cells, mRNA copy numbers of AQP1, AQP3, HMOX1, KCNN4, SCN3B and SOD2 increased, while CACNA1B, CRH decreased in edema. In addition, single pyramidal cells increased the copy number of AQP1, HTR5A and KCNS1 mRNAs in response to increased intracranial pressure. In contrast to pyramidal cells, AQP1, HMOX1and KCNN4 remained unchanged in single cell digital PCR performed on fast spiking cells in edema. Corroborating single cell digital PCR results, pharmacological and immunohistochemical results also suggested the presence of KCNN4 encoding the α-subunit of KCa3.1 channels in edema on pyramidal cells, but not on interneurons. We measured the frequency of spontaneous EPSPs on pyramidal cells in both pathophysiological conditions and on fast spiking interneurons in edema and found a significant decrease in each case, which was accompanied by an increase in input resistances on both cell types and by a drop in dendritic spine density on pyramidal cells consistent with a loss of excitatory synapses. Our results identify anatomical and/or physiological changes in human pyramidal and fast spiking cells in edema and increased intracranial pressure revealing cell type specific quantitative changes in gene expression. Some of the edema

  14. 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.

  15. 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.

  16. Intracranial Pressure Monitoring—Review and Avenues for Development

    Science.gov (United States)

    Dolmans, Rianne G. F.

    2018-01-01

    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. PMID:29401746

  17. Novel method for dynamic control of intracranial pressure.

    Science.gov (United States)

    Luciano, Mark G; Dombrowski, Stephen M; Qvarlander, Sara; El-Khoury, Serge; Yang, Jun; Thyagaraj, Suraj; Loth, Francis

    2017-05-01

    OBJECT Intracranial pressure (ICP) pulsations are generally considered a passive result of the pulsatility of blood flow. Active experimental modification of ICP pulsations would allow investigation of potential active effects on blood and CSF flow and potentially create a new platform for the treatment of acute and chronic low blood flow states as well as a method of CSF substance clearance and delivery. This study presents a novel method and device for altering the ICP waveform via cardiac-gated volume changes. METHODS The novel device used in this experiment (named Cadence) consists of a small air-filled inelastic balloon (approximately 1.0 ml) implanted into the intracranial space and connected to an external programmable pump, triggered by an R-wave detector. Balloons were implanted into the epidural space above 1 of the hemispheres of 19 canines for up to 10 hours. When activated, the balloons were programed to cyclically inflate with the cardiac cycle with variable delay, phase, and volume. The ICP response was measured in both hemispheres. Additionally, cerebral blood flow (heat diffusion and laser Doppler) was studied in 16 canines. RESULTS This system, depending on the inflation pattern of the balloon, allowed a flattening of the ICP waveform, increase in the ICP waveform amplitude, or phase shift of the wave. This occurred with small mean ICP changes, typically around ± 2 mm Hg (15%). Bilateral ICP effects were observed with activation of the device: balloon inflation at each systole increased the systolic ICP pulse (up to 16 mm Hg, 1200%) and deflation at systole decreased or even inverted the systolic ICP pulse (-0.5 to -19 mm Hg, -5% to -1600%) in a dose-(balloon volume) dependent fashion. No aphysiological or deleterious effects on systemic pressure (≤ ±10 mm Hg; 13% change in mean pressure) or cardiac rate (≤ ± 17 beats per minute; 16% change) were observed during up to 4 hours of balloon activity. CONCLUSIONS The results of these initial

  18. Role of Lumbar Drainage as an Adjunct for controlling Intracranial pressure in Acute Bacterial Meningitis

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    G. Gudmundsson

    2013-01-01

    Full Text Available This case report describes a 16-year-old girl with fulminant bacterial meningitis in whom external ventricular drainage and intense volume-targeted therapy (the Lund protocol was not sufficient to control intracranial pressure, but lumbar drainage on day 8 decreased the intracranial pressure immediately and led to a sustained low intracranial pressure level. The case is unusual and not fully understood, but the authors assume that due to inflammation and tissue reactions following aggressive infection, cerebrospinal fluid could not flow freely from the posterior fossa up to the ventricular drain. High pressure in the posterior compartment maintained the high intracranial pressure measured by the ventricular drain, and lumbar drain insertion caused an immediate fall in pressure. The lesson learned is that during an intracranial pressure crisis in a patient with open basal cisterns, a lumbar drain may be necessary because the cerebrospinal fluid space can be compartmentalized.

  19. Characteristics of time-varying intracranial pressure on blood flow through cerebral artery: A fluid-structure interaction approach.

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    Syed, Hasson; Unnikrishnan, Vinu U; Olcmen, Semih

    2016-02-01

    Elevated intracranial pressure is a major contributor to morbidity and mortality in severe head injuries. Wall shear stresses in the artery can be affected by increased intracranial pressures and may lead to the formation of cerebral aneurysms. Earlier research on cerebral arteries and aneurysms involves using constant mean intracranial pressure values. Recent advancements in intracranial pressure monitoring techniques have led to measurement of the intracranial pressure waveform. By incorporating a time-varying intracranial pressure waveform in place of constant intracranial pressures in the analysis of cerebral arteries helps in understanding their effects on arterial deformation and wall shear stress. To date, such a robust computational study on the effect of increasing intracranial pressures on the cerebral arterial wall has not been attempted to the best of our knowledge. In this work, fully coupled fluid-structure interaction simulations are carried out to investigate the effect of the variation in intracranial pressure waveforms on the cerebral arterial wall. Three different time-varying intracranial pressure waveforms and three constant intracranial pressure profiles acting on the cerebral arterial wall are analyzed and compared with specified inlet velocity and outlet pressure conditions. It has been found that the arterial wall experiences deformation depending on the time-varying intracranial pressure waveforms, while the wall shear stress changes at peak systole for all the intracranial pressure profiles. © IMechE 2015.

  20. Paradoxical presentation of orthostatic headache associated with increased intracranial pressure in patients with cerebral venous thrombosis

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    Jung B Kim

    2013-01-01

    Full Text Available Headache is the most common symptom of cerebral venous thrombosis (CVT; however, the detailed underlying mechanisms and characteristics of headache in CVT have not been well described. Here, we report two cases of CVT whose primary and lasting presentation was orthostatic headache, suggestive of decreased intracranial pressure. Contrary to our expectations, the headaches were associated with elevated cerebrospinal fluid (CSF pressure. Magnetic resonance imaging and magnetic resonance venography showed characteristic voiding defects consistent with CVT. We suggest that orthostatic headache can be developed in a condition of decreased intracranial CSF volume in both intracranial hypotensive and intracranial hypertensive states. In these cases, orthostatic headache in CVT might be caused by decreased intracranial CSF volume that leads to the inferior displacement of the brain and traction on pain-sensitive intracranial vessels, despite increased CSF pressure on measurement. CVT should be considered in the differential diagnosis when a patient complains of orthostatic headache.

  1. The interaction between intracranial pressure, intraocular pressure and lamina cribrosal compression in glaucoma.

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    McMonnies, Charles W

    2016-05-01

    This review examines some of the biomechanical consequences associated with the opposing intraocular and intracranial forces. These forces compress the lamina cribrosa and are a potential source of glaucomatous pathology. A difference between them creates a displacement force on the lamina cribrosa. Increasing intraocular pressure and/or decreasing intracranial pressure will increase the trans-lamina cribrosa pressure difference and the risk of its posterior displacement, canal expansion and the formation of pathological cupping. Both intraocular pressure and intracranial pressure can be elevated during a Valsalva manoeuvre with associated increases in both anterior and posterior lamina cribrosa loading as well as its compression. Any resulting thinning of or damage to the lamina cribrosa and/or retinal ganglion cell axons and/or astrocyte and glial cells attached to the matrix of the lamina cribrosa and/or reduction in blood flow to the lamina cribrosa may contribute to glaucomatous neuropathy. Thinning of the lamina cribrosa reduces its stiffness and increases the risk of its posterior displacement. Optic nerve head posterior displacement warrants medical or surgical lowering of intraocular pressure; however, compared to intraocular pressure, the trans-lamina cribrosa pressure difference may be more important in pressure-related pathology of the optic nerve head region. Similarly important could be increased compression loading of the lamina cribrosa. Reducing participation in activities which elevate intraocular and intracranial pressure will decrease lamina cribrosa compression exposure and may contribute to glaucoma management and may have prognostic significance for glaucoma suspects. © 2016 The Authors. Clinical and Experimental Optometry © 2016 Optometry Australia.

  2. Plateau Waves of Intracranial Pressure and Multimodal Brain Monitoring.

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    Dias, Celeste; Maia, Isabel; Cerejo, Antonio; Smielewski, Peter; Paiva, José-Artur; Czosnyka, Marek

    2016-01-01

    The aim of this study was to describe multimodal brain monitoring characteristics during plateau waves of intracranial pressure (ICP) in patients with head injury, using ICM+ software for continuous recording. Plateau waves consist of an abrupt elevation of ICP above 40 mmHg for 5-20 min. This is a prospective observational study of patients with head injury who were admitted to a neurocritical care unit and who developed plateau waves. We analyzed 59 plateau waves that occurred in 8 of 18 patients (44 %). At the top of plateau waves arterial blood pressure remained almost constant, but cerebral perfusion pressure, cerebral blood flow, brain tissue oxygenation, and cerebral oximetry decreased. After plateau waves, patients with a previously better autoregulation status developed hyperemia, demonstrated by an increase in cerebral blood flow and brain oxygenation. Pressure and oxygen cerebrovascular reactivity indexes (pressure reactivity index and ORxshort) increased significantly during the plateau wave as a sign of disruption of autoregulation. Bedside multimodal brain monitoring is important to characterize increases in ICP and give differential diagnoses of plateau waves, as management of this phenomenon differs from that of regular ICP.

  3. Role of ischemic modified albumin in the early diagnosis of increased intracranial pressure and brain death.

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    Kara, I; Pampal, H K; Yildirim, F; Dilekoz, E; Emmez, G; U, F P; Kocabiyik, M; Demirel, C B

    Increased intracranial pressure following trauma and subsequent possible development of brain death are important factors for morbidity and mortality due to ischemic changes. We aimed to establish the role of ischemic modified albumin (IMA) in the early diagnosis of the process, starting with increased intracranial pressure and ending with brain death. Eighteen Wistar-Albino rats were divided into three groups; control (CG, n = 6), increased intracranial pressure (ICPG, n = 6), and brain death (BDG, n = 6). Intracranial pressure elevation and brain death were constituted with the inflation of a balloon of a Fogarty catheter in the epidural space. In all three groups, blood samples were drawn before the procedure, and at minutes 150 and 240 for IMA and malondialdehyde (MDA) analysis. Serum IMA levels at 150 and 240 minutes were higher in ICPG than in CG (p intracranial pressure elevation and ending at brain death (Tab. 3, Fig. 5, Ref. 31).

  4. Noninvasive Assessment of Intracranial Pressure Status in Idiopathic Intracranial Hypertension Using Displacement Encoding with Stimulated Echoes (DENSE) MRI: A Prospective Patient Study with Contemporaneous CSF Pressure Correlation.

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    Saindane, A M; Qiu, D; Oshinski, J N; Newman, N J; Biousse, V; Bruce, B B; Holbrook, J F; Dale, B M; Zhong, X

    2018-02-01

    Intracranial pressure is estimated invasively by using lumbar puncture with CSF opening pressure measurement. This study evaluated displacement encoding with stimulated echoes (DENSE), an MR imaging technique highly sensitive to brain motion, as a noninvasive means of assessing intracranial pressure status. Nine patients with suspected elevated intracranial pressure and 9 healthy control subjects were included in this prospective study. Controls underwent DENSE MR imaging through the midsagittal brain. Patients underwent DENSE MR imaging followed immediately by lumbar puncture with opening pressure measurement, CSF removal, closing pressure measurement, and immediate repeat DENSE MR imaging. Phase-reconstructed images were processed producing displacement maps, and pontine displacement was calculated. Patient data were analyzed to determine the effects of measured pressure on pontine displacement. Patient and control data were analyzed to assess the effects of clinical status (pre-lumbar puncture, post-lumbar puncture, or control) on pontine displacement. Patients demonstrated imaging findings suggesting chronically elevated intracranial pressure, whereas healthy control volunteers demonstrated no imaging abnormalities. All patients had elevated opening pressure (median, 36.0 cm water), decreased by the removal of CSF to a median closing pressure of 17.0 cm water. Patients pre-lumbar puncture had significantly smaller pontine displacement than they did post-lumbar puncture after CSF pressure reduction ( P = .001) and compared with controls ( P = .01). Post-lumbar puncture patients had statistically similar pontine displacements to controls. Measured CSF pressure in patients pre- and post-lumbar puncture correlated significantly with pontine displacement ( r = 0.49; P = .04). This study establishes a relationship between pontine displacement from DENSE MR imaging and measured pressure obtained contemporaneously by lumbar puncture, providing a method to noninvasively

  5. [POSITIVE END-EXPIRATORY PRESSURE (PEEP) INFLUENCES ON INTRACRANIAL PRESSURE, SYSTEMIC HEMODYNAMICS AND PULMONARY GAS EXCHANGE IN PATIENTS WITH INTRACRANIAl HEMORRHAGE IN CRITICAL STATE].

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    Solodov, A A; Petrikov, S S; Krylov, V V

    2016-01-01

    Positive end-expiratory pressure is one of the main parameters of respiratory support influencing the gas exchange. However, despite the number ofpositive effects, PEEP can compromise venous outflow from the cranial cavity, increased intracranial pressure, decreased venous return and cardiac output and, consequently, reduced blood pressure and cerebral perfusion. The article presents the results of a survey of 39 patients with intracranial hemorrhage in critical state, undergoing respiratory support with different levels of positive end-expiratory pressure. Increasing of PEEP to 15 cm H2O had no adverse effect on mean arterial pressure, heart rate and cerebral perfusion pressure and led only to an clinical insignificant increase (maximum on 2.4 +/- 5.1 mmHg) in intracranial pressure. The greatest hemodynamic changes were observed with increasing PEEP up to 20 cm H2O in patients with preserved compliance ofthe respiratory system. The instability of cerebral perfusion and intracranial pressure associated with a decrease in cardiac output and preload and the exhaustion of compensatory mechanism of peripheral vascular resistance. High levels of PEEP despite the trend towards Cstat reduction will not lead to an increase in the content of extravascular lung water Thus a gradual increase of PEEP to 15 cm H2O can be safe and effective method of improving pulmonary gas exchange in patients with intracranial hemorrhage in critical state.

  6. Intracranial Pressure during HighVolume Hemofiltration in Severe Sepsis

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    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.

  7. Radiological Correlates of Raised Intracranial Pressure in Children: A Review

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    Saeed Kayhanian

    2018-02-01

    Full Text Available Radiological assessment of the head is a routine part of the management of traumatic brain injury. This assessment can help to determine the requirement for invasive intracranial pressure (ICP monitoring. The radiological correlates of elevated ICP have been widely studied in adults but far fewer specific pediatric studies have been conducted. There is, however, growing evidence that there are important differences in the radiological presentations of elevated ICP between children and adults; a reflection of the anatomical and physiological differences, as well as a difference in the pathophysiology of brain injury in children. Here in, we review the radiological parameters that correspond with increased ICP in children that have been described in the literature. We then describe the future directions of this work and our recommendations in order to develop non-invasive and radiological markers of raised ICP in children.

  8. Intracranial pressure and cerebral perfusion pressure in patients developing brain death.

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    Salih, Farid; Holtkamp, Martin; Brandt, Stephan A; Hoffmann, Olaf; Masuhr, Florian; Schreiber, Stephan; Weissinger, Florian; Vajkoczy, Peter; Wolf, Stefan

    2016-08-01

    We investigated whether a critical rise of intracranial pressure (ICP) leading to a loss of cerebral perfusion pressure (CPP) could serve as a surrogate marker of brain death (BD). We retrospectively analyzed ICP and CPP of patients in whom BD was diagnosed (n = 32, 16-79 years). Intracranial pressure and CPP were recorded using parenchymal (n = 27) and ventricular probes (n = 5). Data were analyzed from admission until BD was diagnosed. Intracranial pressure was severely elevated (mean ± SD, 95.5 ± 9.8 mm Hg) in all patients when BD was diagnosed. In 28 patients, CPP was negative at the time of diagnosis (-8.2 ± 6.5 mm Hg). In 4 patients (12.5%), CPP was reduced but not negative. In these patients, minimal CPP was 4 to 18 mm Hg. In 1 patient, loss of CPP occurred 4 hours before apnea completed the BD syndrome. Brain death was universally preceded by a severe reduction of CPP, supporting loss of cerebral perfusion as a critical step in BD development. Our data show that a negative CPP is neither sufficient nor a prerequisite to diagnose BD. In BD cases with positive CPP, we speculate that arterial blood pressure dropped below a critical closing pressure, thereby causing cessation of cerebral blood flow. Copyright © 2016 Elsevier Inc. All rights reserved.

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

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    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

  10. Brain herniation in a patient with apparently normal intracranial pressure: a case report

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    Dahlqvist Mats B

    2010-08-01

    Full Text Available Abstract Introduction Intracranial pressure monitoring is commonly implemented in patients with neurologic injury and at high risk of developing intracranial hypertension, to detect changes in intracranial pressure in a timely manner. This enables early and potentially life-saving treatment of intracranial hypertension. Case presentation An intraparenchymal pressure probe was placed in the hemisphere contralateral to a large basal ganglia hemorrhage in a 75-year-old Caucasian man who was mechanically ventilated and sedated because of depressed consciousness. Intracranial pressures were continuously recorded and never exceeded 17 mmHg. After sedation had been stopped, our patient showed clinical signs of transtentorial brain herniation, despite apparently normal intracranial pressures (less than 10 mmHg. Computed tomography revealed that the size of the intracerebral hematoma had increased together with significant unilateral brain edema and transtentorial herniation. The contralateral hemisphere where the intraparenchymal pressure probe was placed appeared normal. Our patient underwent emergency decompressive craniotomy and was tracheotomized early, but did not completely recover. Conclusions Intraparenchymal pressure probes placed in the hemisphere contralateral to an intracerebral hematoma may dramatically underestimate intracranial pressure despite apparently normal values, even in the case of transtentorial brain herniation.

  11. Noninvasive Intracranial Pressure Determination in Patients with Subarachnoid Hemorrhage.

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    Noraky, James; Verghese, George C; Searls, David E; Lioutas, Vasileios A; Sonni, Shruti; Thomas, Ajith; Heldt, Thomas

    2016-01-01

    Intracranial pressure (ICP) should ideally be measured in many conditions affecting the brain. The invasiveness and associated risks of the measurement modalities in current clinical practice restrict ICP monitoring to a small subset of patients whose diagnosis and treatment could benefit from ICP measurement. To expand validation of a previously proposed model-based approach to continuous, noninvasive, calibration-free, and patient-specific estimation of ICP to patients with subarachnoid hemorrhage (SAH), we made waveform recordings of cerebral blood flow velocity in several major cerebral arteries during routine, clinically indicated transcranial Doppler examinations for vasospasm, along with time-locked waveform recordings of radial artery blood pressure (APB), and ICP was measured via an intraventricular drain catheter. We also recorded the locations to which ICP and ABP were calibrated, to account for a possible hydrostatic pressure difference between measured ABP and the ABP value at a major cerebral vessel. We analyzed 21 data records from five patients and were able to identify 28 data windows from the middle cerebral artery that were of sufficient data quality for the ICP estimation approach. Across these windows, we obtained a mean estimation error of -0.7 mmHg and a standard deviation of the error of 4.0 mmHg. Our estimates show a low bias and reduced variability compared with those we have reported before.

  12. Noninvasive assessment of the intracranial pressure in non-traumatic intracranial hemorrhage.

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    Vaiman, Michael; Sigal, Tal; Kimiagar, Itzhak; Bekerman, Inessa

    2016-12-01

    The article describes the modified technique of measuring the diameters of the optic nerve sheath (ONSD) for assessment of the intracranial pressure (ICP) in patients with intracerebral or subarachnoid hemorrhage (SAH). The CT scans of 443 patients were analyzed retrospectively. The ONSDs were measured at 3mm behind the globe and at the point where the ophthalmic artery crosses the optic nerve. The ONSD/eyeball transverse diameter (ETD) ratio was calculated. The correlation analysis was performed with the Glasgow Coma Scale score, Hemispheric Stroke Scale score, Glasgow Outcome Score, and invasive ICP readings. ONSD was enlarged in 95% of patients with intracerebral hemorrhage or SAH. Pathological ONSDs were 6.6±0.8mm (cut-off value >5.5mm; pintracranial hemorrhage and SAH, the presence of ONSD greater than a threshold of 5.5mm is significantly predictive of invasively measured elevated ICP. The prediction of raised ICP can be further refined by measuring ONSD at the point where the optic nerve and the ophthalmic artery cross, and by determining the ratio between the ONSD and ETD. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. [Importance of monitoring neuroendoscopic intracranial pressure during anesthesia for neuroendoscopic surgery: review of 101 cases].

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    Salvador, L; Hurtado, P; Valero, R; Tercero, J; Carrero, E; Caral, L; Ferrer, E; Fábregas, N

    2009-02-01

    The aim of this study was to describe monitoring, anesthetic management, and risk factors for complications in neuroendoscopic surgery. Patients who underwent neuroendoscopy between 1994 and 2003 under general anesthesia, with monitoring of intracranial pressure from inside the neuroendoscope, were studied retrospectively. In some patients, the blood flow rate in the middle cerebral artery was monitored using transcranial Doppler ultrasound. Information was collected related to surgical procedure and the development of complications. Of 101 patients included in the study, transcranial Doppler ultrasound images were available for 20. In 75 patients neuroendoscopic intracranial pressure exceeded 20 mm Hg. Forty-five percent of the patients with available transcranial Doppler ultrasound images showed episodes of reduced diastolic flow rate in the middle cerebral artery during ventricular irrigation. Hemodynamic instability was associated with higher neuroendoscopic intracranial pressures (P < .05). An increase of more than 30 mm Hg in neuroendoscopic intracranial pressure was associated with more postoperative complications, the most common of which was delayed awakening. Procedures that were more complicated than a simple ventriculostomy were performed in 58% of the cases. Mean (SD) neuroendoscopic intracranial pressures in such cases were higher (50.5 [30.9] mm Hg vs 31.8 [25.1 mm Hg] in the simpler procedures) and the postoperative complication rate was higher (P = .003). Neuroendoscopic surgery can causes increases in neuroendoscopic intracranial pressure that are associated with disturbances in cerebral blood flow and complications. This situation demonstrates the importance of monitoring intracranial pressure and cerebral blood flow.

  14. Evaluation of Optical Coherence Tomography to Detect Elevated Intracranial Pressure in Children.

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    Swanson, Jordan W; Aleman, Tomas S; Xu, Wen; Ying, Gui-Shuang; Pan, Wei; Liu, Grant T; Lang, Shih-Shan; Heuer, Gregory G; Storm, Phillip B; Bartlett, Scott P; Katowitz, William R; Taylor, Jesse A

    2017-04-01

    Detecting elevated intracranial pressure in children with subacute conditions, such as craniosynostosis or tumor, may enable timely intervention and prevent neurocognitive impairment, but conventional techniques are invasive and often equivocal. Elevated intracranial pressure leads to structural changes in the peripapillary retina. Spectral-domain (SD) optical coherence tomography (OCT) can noninvasively quantify retinal layers to a micron-level resolution. To evaluate whether retinal measurements from OCT can serve as an effective surrogate for invasive intracranial pressure measurement. This cross-sectional study included patients undergoing procedures at the Children's Hospital of Philadelphia from September 2014 to June 2015. Three groups of patients (n = 79) were prospectively enrolled from the Craniofacial Surgery clinic including patients with craniosynostosis (n = 40). The positive control cohort consisted of patients with hydrocephalus and suspected intracranial hypertension (n = 5), and the negative control cohort consisted of otherwise healthy patients undergoing a minor procedure (n = 34). Spectral-domain OCT was performed preoperatively in all cohorts. Children with cranial pathology, but not negative control patients, underwent direct intraoperative intracranial pressure measurement. The primary outcome was the association between peripapillary retinal OCT parameters and directly measured elevated intracranial pressure. The mean (SD) age was 34.6 (45.2) months in the craniosynostosis cohort (33% female), 48.9 (83.8) months in the hydrocephalus and suspected intracranial hypertension cohort (60% female), and 59.7 (64.4) months in the healthy cohort (47% female). Intracranial pressure correlated with maximal retinal nerve fiber layer thickness (r = 0.60, P ≤ .001), maximal retinal thickness (r = 0.53, P ≤ .001), and maximal anterior retinal projection (r = 0.53, P = .003). Using cut points derived from the

  15. Intracranial Pressure Is a Determinant of Sympathetic Activity.

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    Schmidt, Eric A; Despas, Fabien; Pavy-Le Traon, Anne; Czosnyka, Zofia; Pickard, John D; Rahmouni, Kamal; Pathak, Atul; Senard, Jean M

    2018-01-01

    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 has also to be

  16. Short-duration hypothermia after ischemic stroke prevents delayed intracranial pressure rise.

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    Murtha, L A; McLeod, D D; McCann, S K; Pepperall, D; Chung, S; Levi, C R; Calford, M B; Spratt, N J

    2014-07-01

    Intracranial pressure elevation, peaking three to seven post-stroke is well recognized following large strokes. Data following small-moderate stroke are limited. Therapeutic hypothermia improves outcome after cardiac arrest, is strongly neuroprotective in experimental stroke, and is under clinical trial in stroke. Hypothermia lowers elevated intracranial pressure; however, rebound intracranial pressure elevation and neurological deterioration may occur during rewarming. (1) Intracranial pressure increases 24 h after moderate and small strokes. (2) Short-duration hypothermia-rewarming, instituted before intracranial pressure elevation, prevents this 24 h intracranial pressure elevation. Long-Evans rats with two hour middle cerebral artery occlusion or outbred Wistar rats with three hour middle cerebral artery occlusion had intracranial pressure measured at baseline and 24 h. Wistars were randomized to 2·5 h hypothermia (32·5°C) or normothermia, commencing 1 h after stroke. In Long-Evans rats (n = 5), intracranial pressure increased from 10·9 ± 4·6 mmHg at baseline to 32·4 ± 11·4 mmHg at 24 h, infarct volume was 84·3 ± 15·9 mm(3) . In normothermic Wistars (n = 10), intracranial pressure increased from 6·7 ± 2·3 mmHg to 31·6 ± 9·3 mmHg, infarct volume was 31·3 ± 18·4 mm(3) . In hypothermia-treated Wistars (n = 10), 24 h intracranial pressure did not increase (7·0 ± 2·8 mmHg, P intracranial pressure elevation 24 h after stroke in two rat strains, even after small strokes. Short-duration hypothermia prevented the intracranial pressure rise, an effect sustained for at least 18 h after rewarming. The findings have potentially important implications for design of future clinical trials. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

  17. Intracranial Pressure Monitoring in Infants and Young Children With Traumatic Brain Injury.

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    Dixon, Rebecca R; Nocera, Maryalice; Zolotor, Adam J; Keenan, Heather T

    2016-11-01

    To examine the use of intracranial pressure monitors and treatment for elevated intracranial pressure in children 24 months old or younger with traumatic brain injury in North Carolina between April 2009 and March 2012 and compare this with a similar cohort recruited 2000-2001. Prospective, observational cohort study. Twelve PICUs in North Carolina. All children 24 months old or younger with traumatic brain injury, admitted to an included PICU. None. The use of intracranial pressure monitors and treatments for elevated intracranial pressure were evaluated in 238 children with traumatic brain injury. Intracranial pressure monitoring (risk ratio, 3.7; 95% CI, 1.5-9.3) and intracranial pressure therapies were more common in children with Glasgow Coma Scale less than or equal to 8 compared with Glasgow Coma Scale greater than 8. However, only 17% of children with Glasgow Coma Scale less than or equal to 8 received a monitoring device. Treatments for elevated intracranial pressure were more common in children with monitors; yet, some children without monitors received therapies traditionally used to lower intracranial pressure. Unadjusted predictors of monitoring were Glasgow Coma Scale less than or equal to 8, receipt of cardiopulmonary resuscitation, nonwhite race. Logistic regression showed no strong predictors of intracranial pressure monitor use. Compared with the 2000 cohort, children in the 2010 cohort with Glasgow Coma Scale less than or equal to 8 were less likely to receive monitoring (risk ratio, 0.5; 95% CI, 0.3-1.0), although the estimate was not precise, or intracranial pressure management therapies. Children in the 2010 cohort with a Glasgow Coma Scale less than or equal to 8 were less likely to receive an intracranial pressure monitor or hyperosmolar therapy than children in the 2000 cohort; however, about 10% of children without monitors received therapies to decrease intracranial pressure. This suggests treatment heterogeneity in children 24 months old

  18. Postural effects on intracranial pressure: modeling and clinical evaluation.

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    Qvarlander, Sara; Sundström, Nina; Malm, Jan; Eklund, Anders

    2013-11-01

    The physiological effect of posture on intracranial pressure (ICP) is not well described. This study defined and evaluated three mathematical models describing the postural effects on ICP, designed to predict ICP at different head-up tilt angles from the supine ICP value. Model I was based on a hydrostatic indifference point for the cerebrospinal fluid (CSF) system, i.e., the existence of a point in the system where pressure is independent of body position. Models II and III were based on Davson's equation for CSF absorption, which relates ICP to venous pressure, and postulated that gravitational effects within the venous system are transferred to the CSF system. Model II assumed a fully communicating venous system, and model III assumed that collapse of the jugular veins at higher tilt angles creates two separate hydrostatic compartments. Evaluation of the models was based on ICP measurements at seven tilt angles (0-71°) in 27 normal pressure hydrocephalus patients. ICP decreased with tilt angle (ANOVA: P < 0.01). The reduction was well predicted by model III (ANOVA lack-of-fit: P = 0.65), which showed excellent fit against measured ICP. Neither model I nor II adequately described the reduction in ICP (ANOVA lack-of-fit: P < 0.01). Postural changes in ICP could not be predicted based on the currently accepted theory of a hydrostatic indifference point for the CSF system, but a new model combining Davson's equation for CSF absorption and hydrostatic gradients in a collapsible venous system performed well and can be useful in future research on gravity and CSF physiology.

  19. 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

  20. The quantitative evaluation of intracranial pressure by optic nerve sheath diameter/eye diameter CT measurement.

    Science.gov (United States)

    Bekerman, Inessa; Sigal, Tal; Kimiagar, Itzhak; Ben Ely, Anna; Vaiman, Michael

    2016-12-01

    The changes of the optic nerve sheath diameter (ONSD) have been used to assess changes of the intracranial pressure for 20 years. The aim of this research was to further quantify the technique of measuring the ONSD for this purpose. Retrospective study of computed tomographic (CT) data of 1766 adult patients with intracranial hypotension (n=134) or hypertension (n=1632) were analyzed. The eyeball transverse diameter (ETD) and ONSD were obtained bilaterally, and the ONSD/ETD ratio was calculated. The ratio was used to calculate the normal ONSD for patients and to estimate the intracranial pressure of the patients before and after the onset of the pathology. Correlation analysis was performed with invasively measured intracranial pressure, the presence or absence of papilledema, sex, and age. In hypotension cases, the ONSD by CT was 3.4±0.7 mm (P=.03 against normative 4.4±0.8 mm). In cases with hypertension, the diameter was 6.9±1.3 (P=.02, with a cutoff value ˃5.5 mm). The ONSD/ETD ratio was 0.29±0.04 against 0.19±0.02 in healthy adults (P=.01). The ONSD and the ONSD/ETD ratio can indicate low intracranial pressure, but quantification is impossible at intracranial pressure less than 13 mm Hg. In elevated intracranial pressure, the ONSD and the ratio provide readings that correspond to readings in millimeters of mercury. The ONSD method, reinforced with additional calculations, may help to indicate a raised intracranial pressure, evaluate its severity quantitatively, and establish quantitative goals for treatment of intracranial hypertension, but the limitations of the method are to be taken into account. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Intracranial pressure (ICP) and optic nerve subarachnoid space pressure (ONSP) correlation in the optic nerve chamber: the Beijing Intracranial and Intraocular Pressure (iCOP) study.

    Science.gov (United States)

    Hou, Ruowu; Zhang, Zheng; Yang, Diya; Wang, Huaizhou; Chen, Weiwei; Li, Zhen; Sang, Jinghong; Liu, Sumeng; Cao, Yiwen; Xie, Xiaobin; Ren, Ruojin; Zhang, Yazhuo; Sabel, Bernhard A; Wang, Ningli

    2016-03-15

    Because a lowered intracranial pressure (ICP) is a possible mechanism of optic neuropathy, we wished to study the CSF dynamics in the optic nerve chamber by recording possible changes in the optic nerve subarachnoid space pressure (ONSP) and the impact on it when acutely lowering ICP. In eight normal dogs pressure probes were implanted in the left brain ventricle, lumbar cistern, optic nerve subarachnoid space and in the anterior eye chamber. Following CSF shunting from the brain ventricle we monitored changes of ICP, lumbar cistern pressure (LCP), ONSP and intraocular pressure (IOP). At baseline, the pressures were different with ICP>LCP>ONSP but correlated with each other (PICP (PICP gradually decreased in a linear fashion together with the ONSP ("ICP-depended zone"). But when the ICP fell below a critical breakpoint, ICP and ONSP became uncoupled and ONSP remained constant despite further ICP decline ("ICP-independent zone"). Because the parallel decline of ICP and ONSP breaks down when ICP decreases below a critical breakpoint, we interpret this as a sign of CSF communication arrest between the intracranial and optic nerve SAS. This may be caused by obstructions of either CSF inflow through the optic canal or outflow into the intra-orbital cavity. This CSF exchange arrest may be a contributing factor to optic nerve damage and the optic nerve chamber syndrome which may influence the loss of vision or its restoration. Copyright © 2016 Elsevier B.V. All rights reserved.

  2. 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.

  3. Factors influencing intracranial pressure monitoring guideline compliance and outcome after severe traumatic brain injury.

    NARCIS (Netherlands)

    Biersteker, H.A.; Andriessen, T.M.J.C.; Horn, J.; Franschman, G.; Naalt, J. van der; Hoedemaekers, C.W.E.; Lingsma, H.F.; Haitsma, I.; Vos, P.E.

    2012-01-01

    OBJECTIVE: To determine adherence to Brain Trauma Foundation guidelines for intracranial pressure monitoring after severe traumatic brain injury, to investigate if characteristics of patients treated according to guidelines (ICP+) differ from those who were not (ICP-), and whether guideline

  4. Factors influencing intracranial pressure monitoring guideline compliance and outcome after severe traumatic brain injury

    NARCIS (Netherlands)

    Biersteker, Heleen A. R.; Andriessen, Teuntje M. J. C.; Horn, Janneke; Franschman, Gaby; van der Naalt, Joukje; Hoedemaekers, Cornelia W. E.; Lingsma, Hester F.; Haitsma, Iain; Vos, Pieter E.

    2012-01-01

    Objective: To determine adherence to Brain Trauma Foundation guidelines for intracranial pressure monitoring after severe traumatic brain injury, to investigate if characteristics of patients treated according to guidelines (ICP+) differ from those who were not (ICP-), and whether guideline

  5. Factors influencing intracranial pressure monitoring guideline compliance and outcome after severe traumatic brain injury

    NARCIS (Netherlands)

    Biersteker, Heleen A. R.; Andriessen, Teuntje M. J. C.; Horn, Janneke; Franschman, Gaby; van der Naalt, Joukje; Hoedemaekers, Cornelia W. E.; Lingsma, Hester F.; Haitsma, Iain; Vos, Pieter E.

    Objective: To determine adherence to Brain Trauma Foundation guidelines for intracranial pressure monitoring after severe traumatic brain injury, to investigate if characteristics of patients treated according to guidelines (ICP+) differ from those who were not (ICP-), and whether guideline

  6. Regional cooling for reducing brain temperature and intracranial pressure.

    Science.gov (United States)

    Forte, Luis Vicente; Peluso, Cássio Morano; Prandini, Mirto Nelso; Godoy, Roberto; Rojas, Salomon Soriano Ordinola

    2009-06-01

    To evaluate the effectiveness of regional cooling for reducing brain temperature (BrTe) and intracranial pressure (ICP) in patients where conventional clinical treatment has failed. Regional cooling was carried out using ice bags covering the area of the craniectomy (regional method) in 23 patients. The BrTe and ICP were determined using a fiber optic sensor. Thirteen patients (56.52%) were female. The ages ranged from 16 to 83 years (mean of 48.9). The mean APACHE II score was 25 points (11-35). The patients were submitted, on mean, to 61.7 hours (20-96) of regional cooling. There was a significant reduction in mean BrTe (p<0.0001--from 37.1 degrees C to 35.2 degrees C) and mean ICP (p=0.0001--from 28 mmHg to 13 mmHg). Our results suggest that mild brain hypothermia induced by regional cooling was effective in the control of ICP in patients who had previously undergone decompressive craniectomy.

  7. Moving the patient in bed: effects on intracranial pressure.

    Science.gov (United States)

    Mitchell, P H; Ozuna, J; Lipe, H P

    1981-01-01

    Intracranial pressure (ICP) was measured in 20 patients before and after each of eight nursing care activities: turning the body to four positions, passive range of motion (arm extension and hip flexion), and rotation of the head to the right and to the left. Technically usable data was available for 18 patients. Mean ICP increased for at least five minutes in all patients after one of the four turns and in 88 percent after half the turns. Change in mean ICP with one of a pair of lateral or supine turns was strongly predictive of the direction of change (increase or decrease) of the other turn of the pair. Large increases in ICP occurred in the five patients for whom head rotation was done, while there was minimal change in ICP with both passive range of motion procedures. A cumulative increase in ICP occurred with activities spaced 15 minutes apart, regardless of the nature of the activity. No cumulative increase in ICP was found with procedures spaced at least one hour apart.

  8. Noninvasive monitoring intracranial pressure – A review of available modalities

    Science.gov (United States)

    Khan, Marium Naveed; Shallwani, Hussain; Khan, Muhammad Ulusyar; Shamim, Muhammad Shahzad

    2017-01-01

    Background: Intracranial pressure (ICP) monitoring is important in many neurosurgical and neurological patients. The gold standard for monitoring ICP, however, is via an invasive procedure resulting in the placement of an intraventricular catheter, which is associated with many risks. Several noninvasive ICP monitoring techniques have been examined with the hope to replace the invasive techniques. The goal of this paper is to provide an overview of all modalities that have been used for noninvasive ICP monitoring to date. Methods: A thorough literature search was conducted on PubMed, selected articles were reviewed in completion, and pertinent data was included in the review. Results: A total of 94 publications were reviewed, and we found that over the past few decades clinicians have attempted to use a number of modalities to monitor ICP noninvasively. Conclusion: Although the intraventricular catheter remains the gold standard for monitoring ICP, several noninvasive modalities that can be used in settings when invasive monitoring is not possible are also available. In our opinion, measurement of optic nerve sheath diameter and pupillometry are the two modalities which may prove to be valid options for centers not performing invasive ICP monitoring. PMID:28480113

  9. Noise reduction in intracranial pressure signal using causal shape manifolds.

    Science.gov (United States)

    Rajagopal, Abhejit; Hamilton, Robert B; Scalzo, Fabien

    2016-07-01

    We present the Iterative/Causal Subspace Tracking framework (I/CST) for reducing noise in continuously monitored quasi-periodic biosignals. Signal reconstruction of the basic segments of the noisy signal (e.g. beats) is achieved by projection to a reduced space on which probabilistic tracking is performed. The attractiveness of the presented method lies in the fact that the subspace, or manifold, is learned by incorporating temporal, morphological, and signal elevation constraints, so that segment samples with similar shapes, and that are close in time and elevation, are also close in the subspace representation. Evaluation of the algorithm's effectiveness on the intracranial pressure (ICP) signal serves as a practical illustration of how it can operate in clinical conditions on routinely acquired biosignals. The reconstruction accuracy of the system is evaluated on an idealized 20-min ICP recording established from the average ICP of patients monitored for various ICP related conditions. The reconstruction accuracy of the ground truth signal is tested in presence of varying levels of additive white Gaussian noise (AWGN) and Poisson noise processes, and measures significant increases of 758% and 396% in the average signal-to-noise ratio (SNR).

  10. Blood Pressure Management in Intracranial Hemorrhage: Current Challenges and Opportunities.

    Science.gov (United States)

    Carcel, Cheryl; Sato, Shoichiro; Anderson, Craig S

    2016-04-01

    Non-traumatic intracranial hemorrhage (i.e. intracerebral hemorrhage [ICH] and subarachnoid hemorrhage [SAH]) are more life threatening and least treatable despite being less common than ischemic stroke. Elevated blood pressure (BP) is a strong predictor of poor outcome in both ICH and SAH. Data from a landmark clinical trial INTERACT 2, wherein 2839 participants enrolled with spontaneous ICH were randomly assigned to receive intensive (target systolic BP <140 mmHg) or guideline recommended BP lowering therapy (target systolic BP <180 mmHg), showed that intensive BP lowering was safe, and more favorable functional outcome and better overall health-related quality of life were seen in survivors in the intensive treatment group. These results contributed to the shift in European and American guidelines towards more aggressive early management of elevated BP in ICH. In contrast, the treatment of BP in SAH is less well defined and more complex. Although there is consensus that hypertension needs to be controlled to prevent rebleeding in the acute setting, induced hypertension in the later stages of SAH has questionable benefits.

  11. Cat scratch disease presenting as increased intracranial pressure and aseptic meningitis

    Directory of Open Access Journals (Sweden)

    Ahmad Ameilia

    2015-06-01

    Full Text Available Ocular cat scratch disease (CSD is a condition attributed to infection by Bartonella sp. This condition commonly presents as neuroretinitis. Increased intracranial pressure and aseptic meningitis are rare presentation of CSD. We highlight a case of a 17-year-old female who presented with aseptic meningitis with neuroretinitis and raised intracranial pressure. The patient showed dramatic improvement with antibiotics and her neurological deficits recovered completely within 6 weeks of treatment.

  12. Severe head injuries and intracranial pressure monitoring outcome in Southern Iran

    Directory of Open Access Journals (Sweden)

    Majid Reza Farrokhi

    2006-11-01

    Full Text Available BACKGROUND: Head injury is still a major cause of death and disability. Despite advances in intensive monitoring and clinical practice, little data is available to show the predictive value of intracranial pressure monitoring in assessment of the outcome of head injuries. This study was undertaken to evaluate this predictive value and is the first Iranian study in which ICP monitoring has been included. METHODS: In a prospective study from September 1999 to September 2003, all head- injured patients (53 patients with GCS of 4-8 who were admitted to Nemazee Hospital of Shiraz University of Medical Sciences were included in this study. Subarachnoid screw method or ventricular catheter via ventriculostomy was used to determine intracranial pressure. Patients were monitored for 3 days and were followed for two years at 6-month intervals. RESULTS: Car accidents were the most common cause of head injury (43.3% and 43.3% of patients had GCS of 8. Sixty percent of patients had abnormal intracranial pressure. The patients were most commonly in their first decade of life (18.8% and 81% of patients were male. Controlling increased intracranial pressure was successful in 60% of patients and resulted in a decrease of mortality rate from 60% to 15%. CONCLUSIONS: Early treatment of increased intracranial pressure in head injury patients would be beneficial in reducing mortality and morbidity rates. KEY WORDS: Southern Iran, head injury, outcome, intracranial pressure.

  13. 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

  14. The impact of ocular hemodynamics and intracranial pressure on intraocular pressure during acute gravitational changes.

    Science.gov (United States)

    Nelson, Emily S; Mulugeta, Lealem; Feola, Andrew; Raykin, Julia; Myers, Jerry G; Samuels, Brian C; Ethier, C Ross

    2017-08-01

    Exposure to microgravity causes a bulk fluid shift toward the head, with concomitant changes in blood volume/pressure, and intraocular pressure (IOP). These and other factors, such as intracranial pressure (ICP) changes, are suspected to be involved in the degradation of visual function and ocular anatomical changes exhibited by some astronauts. This is a significant health concern. Here, we describe a lumped-parameter numerical model to simulate volume/pressure alterations in the eye during gravitational changes. The model includes the effects of blood and aqueous humor dynamics, ICP, and IOP-dependent ocular compliance. It is formulated as a series of coupled differential equations and was validated against four existing data sets on parabolic flight, body inversion, and head-down tilt (HDT). The model accurately predicted acute IOP changes in parabolic flight and HDT, and was satisfactory for the more extreme case of inversion. The short-term response to the changing gravitational field was dominated by ocular blood pressures and compliance, while longer-term responses were more dependent on aqueous humor dynamics. ICP had a negligible effect on acute IOP changes. This relatively simple numerical model shows promising predictive capability. To extend the model to more chronic conditions, additional data on longer-term autoregulation of blood and aqueous humor dynamics are needed. NEW & NOTEWORTHY A significant percentage of astronauts present anatomical changes in the posterior eye tissues after spaceflight. Hypothesized increases in ocular blood volume and intracranial pressure (ICP) in space have been considered to be likely factors. In this work, we provide a novel numerical model of the eye that incorporates ocular hemodynamics, gravitational forces, and ICP changes. We find that changes in ocular hemodynamics govern the response of intraocular pressure during acute gravitational change. Copyright © 2017 the American Physiological Society.

  15. 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.

  16. Prospective Evaluation of Noninvasive HeadSense Intracranial Pressure Monitor in Traumatic Brain Injury Patients Undergoing Invasive Intracranial Pressure Monitoring.

    Science.gov (United States)

    Herklots, Martin W; Moudrous, Walid; Oldenbeuving, Annemarie; Roks, Gerwin; Mourtzoukos, Stylianos; Schoonman, Guus G; Ganslandt, Oliver

    2017-10-01

    Currently, intracranial pressure (ICP) is measured by invasive methods with a significant risk of infectious and hemorrhagic complications. Because of these high risks, there is a need for a noninvasive ICP (nICP) monitor with an accuracy similar to that of an invasive ICP (iICP) monitor. We sought to assess prospectively the accuracy and precision of an nICP monitor compared with iICP measurement in severe traumatic brain injury (TBI) patients. Participants were ICP-monitored patients who had sustained TBI. In parallel with the standard invasive ICP measurements, nICP was measured by the HeadSense HS-1000, which is based on sound propagation. The device generated an acoustic signal using a small transmitter, placed in the patient's ear, and picked up by an acoustic sensor placed in the other ear. The signal is then analyzed using proprietary algorithms, and the ICP value is calculated in millimeter of mercury (mm Hg). Analysis of 2911 paired iICP and nICP measurements from 14 severe TBI patients showed a good accuracy of the nICP monitor indicated by a mean difference of 0.5 mm Hg. The precision was also good with a standard deviation of 3.9 mm Hg. The Pearson r correlation was 0.604 (P < 0.001). The HeadSense HS-1000 nICP monitor seems sufficiently accurate to measure the ICP in severe TBI patients, is patient friendly, and has minimal risk of complications. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Comparative observational study on the clinical presentation, intracranial volume measurements, and intracranial pressure scores in patients with either Chiari malformation Type I or idiopathic intracranial hypertension.

    Science.gov (United States)

    Frič, Radek; Eide, Per Kristian

    2017-04-01

    OBJECTIVE Several lines of evidence suggest common pathophysiological mechanisms in Chiari malformation Type I (CMI) and idiopathic intracranial hypertension (IIH). It has been hypothesized that tonsillar ectopy, a typical finding in CMI, is the result of elevated intracranial pressure (ICP) combined with a developmentally small posterior cranial fossa (PCF). To explore this hypothesis, the authors specifically investigated whether ICP is comparable in CMI and IIH and whether intracranial volumes (ICVs) are different in patients with CMI and IIH, which could explain the tonsillar ectopy in CMI. The authors also examined whether the symptom profile is comparable in these 2 patient groups. METHODS The authors identified all CMI and IIH patients who had undergone overnight diagnostic ICP monitoring during the period from 2002 to 2014 and reviewed their clinical records and radiological examinations. Ventricular CSF volume (VV), PCF volume (PCFV), and total ICV were calculated from initial MRI studies by using volumetric software. The static and pulsatile ICP scores during overnight monitoring were analyzed. Furthermore, the authors included a reference (REF) group consisting of patients who had undergone ICP monitoring due to suspected idiopathic normal-pressure hydrocephalus or chronic daily headache and showed normal pressure values. RESULTS Sixty-six patients with CMI and 41 with IIH were identified, with comparable demographics noted in both groups. The occurrence of some symptoms (headache, nausea, and/or vomiting) was comparable between the cohorts. Dizziness and gait ataxia were significantly more common in patients with CMI, whereas visual symptoms, diplopia, and tinnitus were significantly more frequent in patients with IIH. The cranial volume measurements (VV, PCFV, and ICV) of the CMI and IIH patients were similar. Notably, 7.3% of the IIH patients had tonsillar descent qualifying for diagnosis of CMI (that is, > 5 mm). The extent of tonsillar ectopy was

  18. Are Medications Involved in Vision and Intracranial Pressure Changes Seen in Spaceflight

    Science.gov (United States)

    Wotring, Virginia E.

    2015-01-01

    The Food and Drug Association Adverse Event Reports (FDA AER) from 2009-2011 were used to create a database from millions of known and suspected medication-related adverse events among the general public. Vision changes, sometimes associated with intracranial pressure changes (VIIP), have been noted in some long duration crewmembers. Changes in vision and blood pressure (which can subsequently affect intracranial pressure) are fairly common side effects of medications. The purpose of this study was to explore the possibility of medication involvement in crew VIIP symptoms.

  19. Elevation of intracranial pressure in acute AIDS-related cryptococcal meningitis.

    Science.gov (United States)

    Malessa, R; Krams, M; Hengge, U; Weiller, C; Reinhardt, V; Volbracht, L; Rauhut, F; Brockmeyer, N H

    1994-12-01

    Prior to the AIDS-era, elevation of intracranial pressure was known to be a typical complication of cryptococcal meningitis associated with an increased risk of early death. In AIDS-patients, however, the prevalence and clinical significance of this complication are as yet unclear. We analysed clinical features and courses, CSF findings, serological results and neuroimaging scans in acute cryptococcal meningitis in eight patients with AIDS. Five showed symptoms and signs compatible with raised intracranial pressure, which was life-threatening in one and the most probable cause of death in another. Serial monitoring of intracranial pressure together with repeated CSF analysis revealed that severe intracranial pressure elevation in AIDS related cryptococcal meningitis can occur in spite of effective antimycotic treatment, does not depend on an increased CSF/serum osmolality ratio or CSF overproduction and can be associated with normal cranial computed tomography and magnetic resonance imaging findings. Our data support the hypothesis that CSF reabsorption failure plays the crucial role in the pathophysiological mechanism. External lumbar drainage may be of benefit in selected cases of acute AIDS related cryptococcal meningitis with persisting life threatening elevation in intracranial pressure and normal computed tomogram.

  20. High resolution transbulbar sonography in children with suspicion of increased intracranial pressure.

    Science.gov (United States)

    Steinborn, Marc; Friedmann, Melanie; Makowski, Christine; Hahn, Helmut; Hapfelmeier, Alexander; Juenger, Hendrik

    2016-04-01

    To evaluate the accuracy of high resolution transbulbar sonography for the estimation of intracranial pressure (ICP) in children. In children and adolescents with acute neurologic symptoms of various origin, transbulbar sonography was performed. Besides measurement of the optic nerve sheath diameter (ONSD), the ultrastructure of the subarachnoid space of the optic nerve sheath was evaluated. The results of transbulbar sonography were correlated with clinical data based on cross-sectional imaging, ICP measurement, and ophthalmologic examination. Eighty-one patients (age 3-17.8 years, mean 11.7 years) were included. In 25 children, cross-sectional imaging and ICP measurement revealed increased intracranial pressure. The mean ONSD was 6.85 ± 0.81 mm. Twenty patients (20/25, 80 %) had a microcystic appearance of the subarachnoid space of the optic nerve. In 56 children without evidence of increased intracranial pressure, the mean ONSD was 5.77 ± 0.48 mm. Forty-nine patients (49/56, 87.5 %) had a normal homogenous appearance of the subarachnoid space. The ONSD in children with increased intracranial pressure was significantly higher than in patients without (p intracranial pressure in children. Besides measurement of the optic nerve sheath diameter, evaluation of the ultrastructure of the subarachnoid space of the optic nerve is a helpful parameter.

  1. 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

  2. Diagnostic accuracy of intraocular pressure measurement for the detection of raised intracranial pressure: meta-analysis: a systematic review.

    Science.gov (United States)

    Yavin, Daniel; Luu, Judy; James, Matthew T; Roberts, Derek J; Sutherland, Garnette R; Jette, Nathalie; Wiebe, Samuel

    2014-09-01

    Because clinical examination and imaging may be unreliable indicators of intracranial hypertension, intraocular pressure (IOP) measurement has been proposed as a noninvasive method of diagnosis. The authors conducted a systematic review and meta-analysis to determine the correlation between IOP and intracranial pressure (ICP) and the diagnostic accuracy of IOP measurement for detection of intracranial hypertension. The authors searched bibliographic databases (Ovid MEDLINE, Ovid EMBASE, and the Cochrane Central Register of Controlled Trials) from 1950 to March 2013, references of included studies, and conference abstracts for studies comparing IOP and invasive ICP measurement. Two independent reviewers screened abstracts, reviewed full-text articles, and extracted data. Correlation coefficients, sensitivity, specificity, and positive and negative likelihood ratios were calculated using DerSimonian and Laird methods and bivariate random effects models. The I(2) statistic was used as a measure of heterogeneity. Among 355 identified citations, 12 studies that enrolled 546 patients were included in the meta-analysis. The pooled correlation coefficient between IOP and ICP was 0.44 (95% CI 0.26-0.63, I(2) = 97.7%, p intracranial hypertension were 81% (95% CI 26%-98%, I(2) = 95.2%, p intracranial hypertension. Given the significant heterogeneity between included studies, further investigation is required prior to the adoption of IOP in the evaluation of intracranial hypertension into routine practice.

  3. Middle cerebral arterial flow changes on transcranial color and spectral Doppler sonography in patients with increased intracranial pressure.

    Science.gov (United States)

    Wang, Yu; Duan, Yun-You; Zhou, Hai-Yan; Yuan, Li-Jun; Zhang, Li; Wang, Wei; Li, Li-Hong; Li, Liang

    2014-12-01

    Intracranial pressure usually increases after severe brain injury. However, a method for noninvasive evaluation of intracranial pressure is still lacking. The purpose of this study was to explore the potential role of transcranial color Doppler sonography in assessing intracranial pressure by observing the middle cerebral artery blood flow parameters in patients with increased intracranial pressure of varying etiology. The hemodynamic changes in the middle cerebral artery in patients with varying degrees of increased intracranial pressure were investigated by transcranial color Doppler sonography in 93 patients who had emergency surgery for brain injury. Middle cerebral artery Doppler flow spectra changed regularly as intracranial pressure increased. The pulsatility index (PI) and resistive index (RI) had a significantly positive correlation with intracranial pressure (r = 0.90 and 0.89, respectively; Pintracranial pressure (r = -0.52; Pintracranial pressure, with sensitivity of 0.885 and specificity of 0.970. In addition to the PI and RI, middle cerebral artery diastolic flow velocity measurement by transcranial color Doppler sonography may also be a useful variable for evaluating intracranial pressure in patients with acute brain injury. © 2013 by the American Institute of Ultrasound in Medicine.

  4. 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.

  5. Measurement of intracranial pressure and short-term outcomes of patients with traumatic brain injury: a propensity-matched analysis.

    Science.gov (United States)

    Ferreira, Cesar Biselli; Bassi, Estevão; Lucena, Lucas; Carreta, Hernandez; Miranda, Leandro Costa; Tierno, Paulo Fernando Guimarães Mazorcchi; Amorim, Robson Luis; Zampieri, Fernando Godinho; Malbouisson, Luis Marcelo Sá

    2015-01-01

    To assess the impact of intracranial pressure monitoring on the short-term outcomes of traumatic brain injury patients. Retrospective observational study including 299 consecutive patients admitted due to traumatic brain injury from January 2011 through July 2012 at a Level 1 trauma center in São Paulo, Brazil. Patients were categorized in two groups according to the measurement of intracranial pressure (measured intracranial pressure and non-measured intracranial pressure groups). We applied a propensity-matched analysis to adjust for possible confounders (variables contained in the Crash Score prognostic algorithm). Global mortality at 14 days (16%) was equal to that observed in high-income countries in the CRASH Study and was better than expected based on the CRASH calculator score (20.6%), with a standardized mortality ratio of 0.77. A total of 28 patients received intracranial pressure monitoring (measured intracranial pressure group), of whom 26 were paired in a 1:1 fashion with patients from the non-measured intracranial pressure group. There was no improvement in the measured intracranial pressure group compared to the non-measured intracranial pressure group regarding hospital mortality, 14-day mortality, or combined hospital and chronic care facility mortality. Survival up to 14 days was also similar between groups. Patients receiving intracranial pressure monitoring tend to have more severe traumatic brain injuries. However, after adjusting for multiple confounders using propensity scoring, no benefits in terms of survival were observed among intracranial pressure-monitored patients and those managed with a systematic clinical protocol.

  6. Are Medications Involved in Vision and intracranial Pressure Changes Seen in Spaceflight?

    Science.gov (United States)

    Wotring, V. E.

    2016-01-01

    Some crewmembers have experienced changes in their vision after long-duration spaceflight on the ISS. These impairments include visual performance decrements, development of cotton-wool spots or choroidal folds, optic-disc edema, optic nerve sheath distention, and/or posterior globe flattening with varying degrees of severity and permanence. These changes are now used to define the visual impairment/intracranial pressure (VIIP) syndrome. The reasons for these potentially debilitating medical issues are currently unknown. The potential role of administered medications has not yet been examined, but it is known that many medications can have side effects that are similar to VIIP symptoms. Some medications raise blood pressure, which can affect intracranial pressure. Many medications that act in the central nervous system can affect intracranial pressures and/or vision. About 40% of the medications in the ISS kit are known to cause side effects involving changes in blood pressure, intracranial pressure and/or vision. For this reason, we proposed an investigation of the potential relationship between ISS medications and their risk of causing or exacerbating VIIP-like symptoms. The purpose of this study was to use medication usage records for affected and unaffected crew to determine if use of particular medications seemed to correlate with VIIP occurrence or severity.

  7. Predicting Intracranial Pressure and Brain Tissue Oxygen Crises in Patients With Severe Traumatic Brain Injury.

    Science.gov (United States)

    Myers, Risa B; Lazaridis, Christos; Jermaine, Christopher M; Robertson, Claudia S; Rusin, Craig G

    2016-09-01

    To develop computer algorithms that can recognize physiologic patterns in traumatic brain injury patients that occur in advance of intracranial pressure and partial brain tissue oxygenation crises. The automated early detection of crisis precursors can provide clinicians with time to intervene in order to prevent or mitigate secondary brain injury. A retrospective study was conducted from prospectively collected physiologic data. intracranial pressure, and partial brain tissue oxygenation crisis events were defined as intracranial pressure of greater than or equal to 20 mm Hg lasting at least 15 minutes and partial brain tissue oxygenation value of less than 10 mm Hg for at least 10 minutes, respectively. The physiologic data preceding each crisis event were used to identify precursors associated with crisis onset. Multivariate classification models were applied to recorded data in 30-minute epochs of time to predict crises between 15 and 360 minutes in the future. The neurosurgical unit of Ben Taub Hospital (Houston, TX). Our cohort consisted of 817 subjects with severe traumatic brain injury. Our algorithm can predict the onset of intracranial pressure crises with 30-minute advance warning with an area under the receiver operating characteristic curve of 0.86 using only intracranial pressure measurements and time since last crisis. An analogous algorithm can predict the start of partial brain tissue oxygenation crises with 30-minute advanced warning with an area under the receiver operating characteristic curve of 0.91. Our algorithms provide accurate and timely predictions of intracranial hypertension and tissue hypoxia crises in patients with severe traumatic brain injury. Almost all of the information needed to predict the onset of these events is contained within the signal of interest and the time since last crisis.

  8. Systematic review of decreased intracranial pressure with optimal head elevation in postcraniotomy patients: a meta-analysis.

    Science.gov (United States)

    Jiang, Yan; Ye, Zeng pan-pan; You, Chao; Hu, Xin; Liu, Yi; Li, Hao; Lin, Sen; Li, Ji-Pin

    2015-10-01

    To determine an optimal head elevation degree to decrease intracranial pressure in postcraniotomy patients by meta-analysis. A change in head position can lead to a change in intracranial pressure; however, there are conflicting data regarding the optimal degree of elevation that decreases intracranial pressure in postcraniotomy patients. Quantitative systematic review with meta-analysis following Cochrane methods. The data were collected during 2014; three databases (PubMed, Embase and China National Knowledge Internet) were searched for published and unpublished studies in English. The bibliographies of the articles were also reviewed. The inclusion criteria referred to different elevation degrees and effects on intracranial pressure in postcraniotomy patients. According to pre-determined inclusion criteria and exclusion criteria, two reviewers extracted the eligible studies using a standard data form. These included a total of 237 participants who were included in the meta-analysis. (1) Compared with 0 degree: 10, 15, 30 and 45 degrees of head elevation resulted in lower intracranial pressure. (2) Intracranial pressure at 30 degrees was not significantly different in comparison to 45 degrees and was lower than that at 10 and 15 degrees. Patients with increased intracranial pressure significantly benefitted from a head elevation of 10, 15, 30 and 45 degrees compared with 0 degrees. A head elevation of 30 or 45 degrees is optimal for decreasing intracranial pressure. Research about the relationship of position changes and the outcomes of patient primary diseases is absent. © 2015 John Wiley & Sons Ltd.

  9. Baseline pressure errors (BPEs) extensively influence intracranial pressure scores: results of a prospective observational study

    Science.gov (United States)

    2014-01-01

    Background Monitoring of intracranial pressure (ICP) is a cornerstone in the surveillance of neurosurgical patients. The ICP is measured against a baseline pressure (i.e. zero - or reference pressure). We have previously reported that baseline pressure errors (BPEs), manifested as spontaneous shift or drifts in baseline pressure, cause erroneous readings of mean ICP in individual patients. The objective of this study was to monitor the frequency and severity of BPEs. To this end, we performed a prospective, observational study monitoring the ICP from two separate ICP sensors (Sensors 1 and 2) placed in close proximity in the brain. We characterized BPEs as differences in mean ICP despite near to identical ICP waveform in Sensors 1 and 2. Methods The study enrolled patients with aneurysmal subarachnoid hemorrhage in need of continuous ICP monitoring as part of their intensive care management. The two sensors were placed close to each other in the brain parenchyma via the same burr hole. The monitoring was performed as long as needed from a clinical perspective and the ICP recordings were stored digitally for analysis. For every patient the mean ICP as well as the various ICP wave parameters of the two sensors were compared. Results Sixteen patients were monitored median 164 hours (ranges 70 – 364 hours). Major BPEs, as defined by marked differences in mean ICP despite similar ICP waveform, were seen in 9 of them (56%). The BPEs were of magnitudes that had the potential to alter patient management. Conclusions Baseline Pressure Errors (BPEs) occur in a significant number of patients undergoing continuous ICP monitoring and they may alter patient management. The current practice of measuring ICP against a baseline pressure does not comply with the concept of State of the Art. Monitoring of the ICP waves ought to become the new State of the Art as they are not influenced by BPEs. PMID:24472296

  10. [SIMULTANEOUS MEASUREMENT OF INTRAVENTRICULAR AND PARENCHYMAL INTRACRANIAL PRESSURE IN PATIENTS WITH SEVERE TRAUMA BRAIN INJURY].

    Science.gov (United States)

    Oshorov, A V; Popugaev, K A; Savin, I A; Potapov, A A

    2016-01-01

    "Standard" assessment of ICP by measuring liquor ventricular pressure recently questioned. THE OBJECTIVE OF THE STUDY: Compare the values of ventricular and parenchymal ICP against the closure of open liquor drainage and during active CSF drainage. Examined 7 patients with TBI and intracranial hypertension syndrome, GCS 5.6 ± 1.2 points, 4.2 ± age 33 years. Compared parenchymal and ventricular ICP in three time periods: 1--during closure of ventricular drainage, 2--during of the open drains and drainage at the level of 14-15 mmHg, 3--during the period of active drainage. When comparing two methods of measurement used Bland-Altman method. 1. During time period of the closed drainage correlation coefficient was r = 0.83, p intracranial pressure is reduced. 3. During the active CSF drainage correlation between the two methods of measuring intracranial pressure can be completely lost. Under these conditions, CSF pressure is not correctly reflect the ICP 4. For an accurate and continuous measurement of intracranial pressure on the background of the active CSF drainage should be carried out simultaneous parenchymal ICP measurement.

  11. Correlation of the intraocular pressure with increased intracranial pressure in rabbits

    Directory of Open Access Journals (Sweden)

    Eskandari H

    2000-08-01

    Full Text Available Although measurement of intracranial pressure by noninvasive methods has been suggested, but mainly invasive methods are used for this purpose-Increase in episcleral venous pressure can be expected to result in a linear increase in intraocular pressure. Congested oculat veins with capillary leakage and hemorrhage are seen when the ICP is increased, thus theoretically measurement of intraocular pressure can be a procedure for estimation of the ICP. This study was performed to find whether there is andy relationship between intraocular pressure and ICP, so we used 12 albino rabbits in two divided groups. Our study was not designed to elucidate the mechanism of change but merely to record any changes observed. All measures except an increase in ICP were applied on the test group as well as on the control group. After general anesthesia with the combination of ketamin, rampune, and pentobarbital a burr hole was made in the lambda region of the skull and a cannula was placed in the subdural space. The ICP in the test group increased up to 15 mmHg and was constant throughout the experiment. Intraocular pressure was measured by Schiotz tonometers afte general anesthesia, after cannulation of the skull, and immediately after increasing the ICP which was repated in 15 minutes interval for 4 hours. There was no statistical difference between the two groups (P:0.997 . results show that neither cannulation nor general anesthesia for 4 hours produce alteration in IOP in the control group nor increasing of the ICP to level of 15 mmHg produces any alteration in IOP on the test group.

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

    Science.gov (United States)

    2011-01-01

    Background 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. Methods 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 Results 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. Conclusions 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. PMID:21859487

  13. 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.

  14. 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.

  15. 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...

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

    African Journals Online (AJOL)

    Raised ICP can be defined in many ways, but in the acute setting it commonly refers to pressure greater than .... Hypertensive encephalopathy (malignant hypertension, eclampsia). Metabolic encephalopathy. Hypoxic-ischaemic ... Idiopathic intracranial hypertension. ICP varies over the course of the day and is influenced.

  17. Acetazolamide lowers intracranial pressure and modulates the cerebrospinal fluid secretion pathway in healthy rats

    DEFF Research Database (Denmark)

    Uldall, Maria; Botfield, Hannah; Jansen-Olesen, Inger

    2017-01-01

    Acetazolamide is one of the most widely used drugs for lowering intracranial pressure (ICP) and is believed to reduce cerebrospinal fluid (CSF) secretion via its action on the choroid plexus (CP). In the CP the main driving force for CSF secretion is primarily active transport of Na...

  18. 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

  19. 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...

  20. The prognostic reliability of intracranial pressure monitoring and MRI data in severe traumatic brain injury.

    Science.gov (United States)

    Woischneck, Dieter; Kapapa, Thomas

    2017-02-01

    The predictive quality of intracranial pressure (ICP) monitoring has for many years been a matter of debate. We correlate ICP data comparing MRI data with the outcome after severe traumatic brain injury to evaluate their prognostic potency. This study compares the results of ICP monitoring, MRI, coma duration and outcome according to Glasgow Outcome Scale obtained in 32 patients having suffered severe TBI. Level of significance was set to p≤0.05 in statistical tests. The MRI results were closely correlated with coma duration and Glasgow Outcome Scale, but the ICP measurements were not. With the exception of severe, bipontine lesions, there is no other region of the brain in which increased evidence of traumatogenic lesions emerges as the intracranial pressure rises. Just bipontine lesions that proof to be infaust correlate with elevated ICP values. ICP monitoring does not allow individual prognostic conclusions to be made. Implantation of an intracranial pressure sensor alone for making a prognostic estimate is not advisable. The use of intracranial pressure measurements in the retrospective appraisal of disease progress is highly problematic. However, MRI diagnostic in patients with severe TBI improves prognostic potency of clinical parameters. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. 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.

  2. 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...

  3. Detection of intracochlear and intracranial pressure changes with otoacoustic emissions : a gerbil model

    NARCIS (Netherlands)

    Buki, B; de Kleine, E; Wit, HP; Avan, P

    Increased intracranial pressure (ICP) is known to affect the phases and levels of lower-frequency distortion-product otoacoustic emissions (DPOAE) in a characteristic: manner suggestive of an increase in the stiffness of the stapes system. likely in relation to an attendant increased intracochlear

  4. Refractory High Intracranial Pressure following Intraventricular Hemorrhage due to Moyamoya Disease in a Pregnant Caucasian Woman

    Directory of Open Access Journals (Sweden)

    Virginie Montiel

    2009-02-01

    Full Text Available Intraventricular hemorrhage during pregnancy is usually followed by a poor recovery. When caused by moyamoya disease, ischemic or hemorrhagic episodes may complicate the management of high intracranial pressure. A 26-year-old Caucasian woman presented with generalized seizures and a Glasgow Coma Score (GCS of 3 during the 36th week of pregnancy. The fetus was delivered by caesarean section. The brain CT in the mother revealed bilateral intraventricular hemorrhage, a callosal hematoma, hydrocephalus and right frontal ischemia. Refractory high intracranial pressure developed and required bilateral ventricular drainage and intensive care treatment with barbiturates and hypothermia. Magnetic resonance imaging and cerebral angiography revealed a moyamoya syndrome with rupture of the abnormal collateral vascular network as the cause of the hemorrhage. Intracranial pressure could only be controlled after the surgical removal of the clots after a large opening of the right ventricle. Despite an initially low GCS, this patient made a good functional recovery at one year follow-up. Management of refractory high intracranial pressure following moyamoya related intraventricular bleeding should require optimal removal of ventricular clots and appropriate control of cerebral hemodynamics to avoid ischemic or hemorrhagic complications.

  5. Relationships among neuroscore, magnetic resonance imaging features, and intracranial pressure in sheep affected by slow-growing brain lesions.

    Science.gov (United States)

    Evangelisti, Maria A; Deiana, Roberta; Melosu, Valentino; Burrai, Giovanni P; Ballocco, Isabella; Varcasia, Antonio; Scala, Antonio; Manunta, Maria L

    2017-12-22

    Diagnosing high intracranial pressure by clinical and diagnostic imaging is particularly challenging for chronic or slow-growing lesions. The aim of this prospective case-control study is to determine whether the neuroscore and brain magnetic resonance imaging (MRI) are related to the direct measurement of intracranial pressure in sheep affected by intracranial slow-growing lesions due to chronic cerebral coenurosis (Coenurus cerebralis). Seventeen affected and 10 control sheep were included. All animals underwent a neurological examination, MRI of the brain, and direct measurement of intracranial pressure. The severity of clinical signs and MRI findings were scored. Data were statistically analyzed. The invasive intracranial pressure value was higher in affected animals. A severely altered neuroscore is related to an increased intracranial pressure beyond the normal threshold (P intracranial hypertension. In conclusion, this study shows that in sheep affected by slow-growing lesions, severe alterations in the neuroscore and the results of objective MRI are related to an increased intracranial pressure beyond the normal threshold. © 2017 American College of Veterinary Radiology.

  6. The relationship between intracranial pressure and lactate/pyruvate ratio in patients with subarachnoid haemorrhage.

    Science.gov (United States)

    Cesak, T; Adamkov, J; Habalova, J; Poczos, P; Kanta, M; Bartos, M; Hosszu, T

    2018-01-01

    The aim of this study was to analyse the relationship between intracranial pressure (intracranial pressure monitoring) and lactate pyruvate ratio (cerebral microdialysis) in patients with ruptured intracranial aneurysms. In a group of fifteen patients, intracranial pressure and lactate/pyruvate ratios were measured and logged in hourly intervals. The relationship between these two variables was subsequently analysed in two ways. 1) Intracranial hypertension (ICP > 20 mmHg) in the presence of energy deprivation (L/P ratio > 30) was noted. 2) The dynamics of L/P ratio changes in relation to immediate ICP and CPP values was analysed. Out of a total of 1873 monitored hours we were able to record lactate/pyruvate ratios higher than 30 in 832 hours (44 %). Of those 832 hours during which lactate/pyruvate ratios were higher than 30, ICP was higher than 20 in 193 hours (23 %). Out of 219 hours of monitoring, in which ICP was higher than 20, a simultaneously increased L/P ratio higher than 30 was recorded in 193 hours (88 %). L/P ratio values above 30 were associated with decreased CPP values (p = 0.04), but not with increased ICP values (p = 0.79). Intracranial hypertension coincides with energetic imbalance in approximately one quarter of cases. This points to the shortcomings of the most common form of neuromonitoring in SAH patients - ICP monitoring. This method may not be reliable enough in detecting hypoxic damage, which is the major cause of morbidity and mortality in SAH patients (Fig. 5, Ref. 11).

  7. A method for estimating zero-flow pressure and intracranial pressure.

    Science.gov (United States)

    Marzban, Caren; Illian, Paul R; Morison, David; Moore, Anne; Kliot, Michel; Czosnyka, Marek; Mourad, Pierre D

    2013-01-01

    It has been hypothesized that the critical closing pressure of cerebral circulation, or zero-flow pressure (ZFP), can estimate intracranial pressure (ICP). One ZFP estimation method used extrapolation of arterial blood pressure as against blood-flow velocity. The aim of this study was to improve ICP predictions. Two revisions have been considered: (1) the linear model used for extrapolation is extended to a nonlinear equation; and (2) the parameters of the model are estimated by an alternative criterion (not least squares). The method is applied to data on transcranial Doppler measurements of blood-flow velocity, arterial blood pressure, and ICP from 104 patients suffering from closed traumatic brain injury, sampled across the United States and England. The revisions lead to qualitative (eg, precluding negative ICP) and quantitative improvements in ICP prediction. While moving from the original to the revised method, the ±2 SD of the error is reduced from 33 to 24 mm Hg, and the root-mean-squared error is reduced from 11 to 8.2 mm Hg. The distribution of root-mean-squared error is tighter as well; for the revised method the 25th and 75th percentiles are 4.1 and 13.7 mm Hg, respectively, as compared with 5.1 and 18.8 mm Hg for the original method. Proposed alterations to a procedure for estimating ZFP lead to more accurate and more precise estimates of ICP, thereby offering improved means of estimating it noninvasively. The quality of the estimates is inadequate for many applications, but further work is proposed, which may lead to clinically useful results.

  8. Telemetric Intracranial Pressure Monitoring with the Raumedic Neurovent P-tel.

    Science.gov (United States)

    Antes, Sebastian; Tschan, Christoph A; Heckelmann, Michael; Breuskin, David; Oertel, Joachim

    2016-07-01

    Devices enabling long-term intracranial pressure monitoring have been demanded for some time. The first solutions using telemetry were proposed in 1967. Since then, many other wireless systems have followed but some technical restrictions have led to unacceptable measurement uncertainties. In 2009, a completely revised telemetric pressure device called Neurovent P-tel was introduced to the market. This report reviews technical aspects, handling, possibilities of data analysis, and the efficiency of the probe in clinical routine. The telemetric device consists of 3 main parts: the passive implant, the active antenna, and the storage monitor. The implant with its parenchymal pressure transducer is inserted via a frontal burr hole. Pressure values can be registered with a frequency of 1 Hz or 5 Hz. Telemetrically gathered data can be viewed on the storage monitor or saved on a computer for detailed analyses. A total of 247 patients with suspected (n = 123) or known (n = 124) intracranial pressure disorders underwent insertion of the telemetric pressure probe. A detailed analysis of the long-term intracranial pressure profile including mean values, maximum and negative peaks, pathologic slow waves, and pulse pressure amplitudes is feasible using the detection rate of 5 Hz. This enables the verification of suspected diagnoses as normal-pressure hydrocephalus, benign intracranial hypertension, shunt malfunction, or shunt overdrainage. Long-term application also facilitates postoperative surveillance and supports valve adjustments of shunt-treated patients. The presented telemetric measurement system is a valuable and effective diagnostic tool in selected cases. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. 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...... unit environment. Methods The authors established a test setup in the neurointensive care unit using a large container filled with isotonic saline, creating a phantom patient. Intracranial pressure monitors were sequentially lowered into the container and subjected to a predefined test battery of ESDs....... 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...

  10. Management of raised intracranial pressure in children with traumatic brain injury

    Science.gov (United States)

    Kukreti, Vinay; Mohseni-Bod, Hadi; Drake, James

    2014-01-01

    Increased intracranial pressure (ICP) is associated with worse outcome after traumatic brain injury (TBI). The current guidelines and management strategies are aimed at maintaining adequate cerebral perfusion pressure and treating elevated ICP. Despite controversies, ICP monitoring is important particularly after severe TBI to guide treatment and in developed countries is accepted as a standard of care. We provide a narrative review of the recent evidence for the use of ICP monitoring and management of ICP in pediatric TBI. PMID:25624921

  11. Intracranial Pressure and Its Relationship to Glaucoma: Current Understanding and Future Directions

    Science.gov (United States)

    ROY CHOWDHURY, Uttio; FAUTSCH, Michael P.

    2015-01-01

    Retrospective and prospective studies looking at the role of cerebrospinal fluid pressure (CSFP)/intracranial pressure (ICP) have stimulated new theories and hypotheses regarding the underlying causal events for glaucoma. Most recently, studies supporting a low CSFP/ICP as a risk factor for glaucoma have been published. This review summarizes the current understanding of CSFP/ICP and its potential role in the pathogenicity of the disease. PMID:27350948

  12. The Effect of Positive End-Expiratory Pressure on Intracranial Pressure and Cerebral Hemodynamics.

    Science.gov (United States)

    Boone, Myles D; Jinadasa, Sayuri P; Mueller, Ariel; Shaefi, Shahzad; Kasper, Ekkehard M; Hanafy, Khalid A; O'Gara, Brian P; Talmor, Daniel S

    2017-04-01

    Lung protective ventilation has not been evaluated in patients with brain injury. It is unclear whether applying positive end-expiratory pressure (PEEP) adversely affects intracranial pressure (ICP) and cerebral perfusion pressure (CPP). We aimed to evaluate the effect of PEEP on ICP and CPP in a large population of patients with acute brain injury and varying categories of acute lung injury, defined by PaO 2 /FiO 2 . Retrospective data were collected from 341 patients with severe acute brain injury admitted to the ICU between 2008 and 2015. These patients experienced a total of 28,644 paired PEEP and ICP observations. Demographic, hemodynamic, physiologic, and ventilator data at the time of the paired PEEP and ICP observations were recorded. In the adjusted analysis, a statistically significant relationship between PEEP and ICP and PEEP and CPP was found only among observations occurring during periods of severe lung injury. For every centimeter H 2 O increase in PEEP, there was a 0.31 mmHg increase in ICP (p = 0.04; 95 % CI [0.07, 0.54]) and a 0.85 mmHg decrease in CPP (p = 0.02; 95 % CI [-1.48, -0.22]). Our results suggest that PEEP can be applied safely in patients with acute brain injury as it does not have a clinically significant effect on ICP or CPP. Further prospective studies are required to assess the safety of applying a lung protective ventilation strategy in brain-injured patients with lung injury.

  13. Pressure inside the neuroendoscope: correlation with epidural intracranial pressure during neuroendoscopic procedures.

    Science.gov (United States)

    Salvador, Lydia; Valero, Ricard; Carazo, Jesús; Caral, Luis; Rios, José; Carrero, Enrique; Tercero, Javier; de Riva, Nicolas; Hurtado, Paola; Ferrer, Enrique; Fábregas, Neus

    2010-07-01

    During neuroendoscopic procedures, pressure inside the neuroendoscope (PIN) monitored through the irrigation channel correlates with the occurrence of postoperative complications. Our aim was to analyze the reliability of PIN measurement as a surrogate for intracranial pressure (ICP) by comparing PIN with simultaneously epidural ICP measurement as the standard. Seventeen consecutive patients undergoing neuroendoscopy were studied prospectively. Type and length of procedure and PIN and epidural ICP values during neuroendoscopy were recorded. Lin's concordance coefficient and Bland-Altman analysis of agreement were used to assess correspondence between the 2 systems. A consistent relation between PIN and epidural ICP waveforms was observed during neuroendoscopic navigation. A strong Pearson correlation between PIN and epidural ICP data were found in 15 patients. Epidural ICP values were systematically higher than PIN values in 15 patients. Lin concordance coefficients showed moderate global agreement between the 2 methods, at 0.58 (95% confidence interval, 0.577-0.592). In 6 cases (35.2%) concordance was good according to this analysis, in 7 cases (41.2%) agreement was moderate/fair, and in 4 cases (23.5%) agreement was poor. The Bland-Altman analysis of patient data showed good agreement between the PIN and epidural ICP measurements for most patients, although discrepancies were greater at higher ICP values for 11 patients. Bland-Altman analysis of the complete dataset, after the normalization of individual's measurements, showed good overall agreement. PIN measurement seems useful for evaluating ICP changes related to neuroendoscopic procedures and seems to be more consistent than epidural ICP at high pressures.

  14. Intracranial pressure monitoring after primary decompressive craniectomy in traumatic brain injury: a clinical study.

    Science.gov (United States)

    Picetti, Edoardo; Caspani, Maria Luisa; Iaccarino, Corrado; Pastorello, Giulia; Salsi, Pierpaolo; Viaroli, Edoardo; Servadei, Franco

    2017-04-01

    Intracranial pressure (ICP) monitoring represents an important tool in the management of traumatic brain injury (TBI). Although current information exists regarding ICP monitoring in secondary decompressive craniectomy (DC), little is known after primary DC following emergency hematoma evacuation. Retrospective analysis of prospectively collected data. Inclusion criteria were age ≥18 years and admission to the intensive care unit (ICU) for TBI and ICP monitoring after primary DC. Exclusion criteria were ICU length of stay (LOS) pressure (CPP) after primary DC, (2) to evaluate the relationship between ICP/CPP and neurological outcome and (3) to characterize and evaluate ICP-driven therapies after DC. A total of 34 patients were enrolled. Over 308 days of ICP/CPP monitoring, 130 days with at least one episode of intracranial hypertension (26 patients, 76.5%) and 57 days with at least one episode of CPP intracranial hypertension was treated with: barbiturate coma (n = 7, 20.6%), external ventricular drain (EVD) (n = 4, 11.8%), DC diameter widening (n = 1, 2.9%) and removal of newly formed hematomas (n = 3, 8.8%). Intracranial hypertension and/or low CPP occurs frequently after primary DC; their occurence is associated with an unfavorable neurological outcome. ICP monitoring appears useful in guiding therapy after primary DC.

  15. Continuous monitoring of intracranial pressure for prediction of postoperative complications of hypertensive intracerebral hemorrhage.

    Science.gov (United States)

    Yu, S-X; Zhang, Q-S; Yin, Y; Liu, Z; Wu, J-M; Yang, M-X

    2016-11-01

    This study evaluates the value of continuous dynamic monitoring of intracranial pressure (ICP) in patients with hypertensive intracerebral hemorrhage to predict early postoperative complications. Data from 80 patients treated in our hospital from February 2014 to February 2015 were analyzed. The patients all underwent decompressive craniectomies, and their ICP changes were monitored invasively and continuously for 1 to 7 days after surgery. The average blood loss during surgery for the group of patients was 65.3 ± 12.4 ml and the mean GCS score 8.7 ± 2.4. Cases were divided into three groups according to ICP values to compare early postoperative complications of the groups: a normal and mildly increased group (51 cases), a moderately increased group (19 cases) and a severely increased group (10 cases). To validate the analysis we first showed that comparisons among groups based on gender, age, systolic pressure, diastolic pressure, bleeding time, blood loss, operation time, craniectomy localization, and preoperative mannitol dosage yielded no statistically significant differences. In contrast, the following comparisons produced statistically significant differences: the comparison of postoperative Glasgow Coma Scale (GCS) scores showing that the lower intracranial pressure, the higher the GCS score; the postoperative rehemorrhage, cerebral edema and death ratios showing the higher the intracranial pressure, the higher the rehemorrhage ratio; the average ICP and the time to occurrence of rehemorrhage, cerebral edema or cerebral infarction, showing the relationship between the average ICP and the time to a complication. Patients with higher ICP averages suffered a complication of rehemorrhage within the first 9.6 ± 2.5 hours on average. Nevertheless, the comparison of GCS scores in those patients and the others showed no significant differences. Based on the findings, the dynamic monitoring of intracranial pressure can early and sensitively predict postoperative

  16. The influence of hyperthermia on intracranial pressure, cerebral oximetry and cerebral metabolism in traumatic brain injury

    Science.gov (United States)

    Nyholm, Lena; Howells, Tim; Lewén, Anders; Hillered, Lars; Enblad, Per

    2017-01-01

    Background Hyperthermia is a common secondary insult in traumatic brain injury (TBI). The aim was to evaluate the relationship between hyperthermia and intracranial pressure (ICP), and if intracranial compliance and cerebral blood flow (CBF) pressure autoregulation affected that relationship. The relationships between hyperthermia and cerebral oximetry (BtipO2) and cerebral metabolism were also studied. Methods A computerized multimodality monitoring system was used for data collection at the neurointensive care unit. Demographic and monitoring data (temperature, ICP, blood pressure, microdialysis, BtipO2) were analyzed from 87 consecutive TBI patients. ICP amplitude was used as measure of compliance, and CBF pressure autoregulation status was calculated using collected blood pressure and ICP values. Mixed models and comparison between groups were used. Results The influence of hyperthermia on intracranial dynamics (ICP, brain energy metabolism, and BtipO2) was small, but individual differences were seen. Linear mixed models showed that hyperthermia raises ICP slightly more when temperature increases in the groups with low compliance and impaired CBF pressure autoregulation. There was also a tendency (not statistically significant) for increased BtipO2, and for increased pyruvate and lactate, with higher temperature, while the lactate/pyruvate ratio and glucose were stable. Conclusions The major finding was that the effects of hyperthermia on intracranial dynamics (ICP, brain energy metabolism, and BtipO2) were not extensive in general, but there were exceptional cases. Hyperthermia treatment has many side effects, so it is desirable to identify cases in which hyperthermia is dangerous. Information from multimodality monitoring may be used to guide treatment in individual patients. PMID:28463046

  17. 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

    2017-08-02

    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. © The Author 2017. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e

  18. Intracranial arachnoid cysts; A quantitative analysis of fluid dynamics and continuous intracystic pressure monitoring

    International Nuclear Information System (INIS)

    Oi, Shizuo; Shose, Yoshiteru; Okuda, Yasuhiro; Yamada, Hiroshi; Ijichi, Akihiro; Matsumoto, Satoshi.

    1986-01-01

    The natural history and pathophysiology of intracranial arachnoid cysts are still obscure. The purpose of this paper is to analyze the characteristics of the fluid dynamics of arachnoid cysts by utilizing the quantitative analysis method of metrizamide CT cisternography (CTCG). These results are then compared with those of intracystic pressure dynamics. We discuss the pathophysiology of and the operative indication for intracranial arachnoid cysts. The patterns of fluid dynamics in arachnoid cysts in the major pathway of CSF circulation are various. It is not possible to classify 3 or 4 types of cyst-CSF circulation patterns, as has been done in many previous reports, with just this quantitative analysis method, namely, CTCG. There was no close correlation between the type of fluid communication and either clinical symptoms or intracystic pressure dynamics. From these points of view, it was suggested that the operative or therapeutic goal in treating arachnoid cysts is to normalize the pressure dynamics, which are likely to damage the regional brain function with its expansile ballooning pressure in non-communicating cysts or stagnating fluid force in communicating cysts. We hereby propose a new concept of ''localized hydrocephalus'' with regard to intracranial arachnoid cysts. (author)

  19. The Upper Limit of Cerebral Blood Flow Autoregulation Is Decreased with Elevations in Intracranial Pressure.

    Science.gov (United States)

    Pesek, Matthew; Kibler, Kathleen; Easley, R Blaine; Mytar, Jennifer; Rhee, Christopher; Andropolous, Dean; Brady, Ken

    2016-01-01

    The upper limit of cerebrovascular pressure autoregulation (ULA) is inadequately characterized. We sought to delineate the ULA in a neonatal swine model. Neonatal piglets with sham surgery (n = 9), interventricular fluid infusion (INF; n = 10), controlled cortical impact (CCI; n = 10), or impact + infusion (CCI + INF; n = 11) had intracranial pressure monitoring and bilateral cortical laser-Doppler flux recordings during arterial hypertension until lethality. An increase in red cell flux as a function of cerebral perfusion pressure was determined by piecewise linear regression and static rates of autoregulation (SRoRs) were determined above and below this inflection. When identified, the ULA (median [interquartile range]) was as follows: sham group: 102 mmHg (97-109), INF group: 75 mmHg (52-84), CCI group: 81 mmHg (69-101), and CCI + INF group: 61 mmHg (52-57; p = 0.01). Both groups with interventricular infusion had significantly lower ULA compared with the sham group. Neonatal piglets without intracranial pathological conditions tolerated acute hypertension, with minimal perturbation of cerebral blood flow. Piglets with acutely elevated intracranial pressure, with or without trauma, demonstrated loss of autoregulation when subjected to arterial hypertension.

  20. 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.

  1. Adult Neuroblastoma Complicated by Increased Intracranial Pressure: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Patrick L. Stevens

    2014-01-01

    Full Text Available Neuroblastoma is the third most commonly occurring malignancy of the pediatric population, although it is extremely rare in the adult population. In adults, neuroblastoma is often metastatic and portends an extremely poor overall survival. Our case report documents metastatic neuroblastoma occurring in a healthy 29-year-old woman whose course was complicated by an unusual presentation of elevated intracranial pressures. The patient was treated with systemic chemotherapy, I131 metaiodobenzylguanidine (MIBG radiotherapy, and autologous stem cell transplant (SCT. Unfortunately the patient’s response to therapy was limited and she subsequently died. We aim to review neuroblastoma in the context of increased intracranial pressure and the limited data of neuroblastoma occurring in the adult population, along with proposed treatment options.

  2. Choroid plexus aquaporin 1 and intracranial pressure are increased in obese rats

    DEFF Research Database (Denmark)

    Uldall, M; Bhatt, D K; Kruuse, C

    2017-01-01

    furthermore investigated expression profiles of aquaporin 1 (AQP1) and Na/K ATPase. METHODS: ICP was measured in obese and lean Zucker rats over a period of 28 days. Arterial pCO2and serum retinol were measured in serum samples. The CPs were isolated, and target messenger RNA (mRNA) and protein were analyzed......BACKGROUND/OBJECTIVES: Idiopathic intracranial hypertension (IIH) is a condition of increased intracranial pressure (ICP) without identifiable cause. The majority of IIH patients are obese, which suggests a connection between ICP and obesity. The aim of the study was to compare ICP in lean...... and obese rats. We also aimed to clarify if any ICP difference could be attributed to changes in some well-known ICP modulators; retinol and arterial partial pressure of CO2(pCO2). Another potential explanation could be differences in water transport across the choroid plexus (CP) epithelia, and thus we...

  3. 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

  4. Influence of an increased intracranial pressure on cerebral and systemic haemodynamics during endoscopic neurosurgery : an animal model

    NARCIS (Netherlands)

    Kalmar, A. F.; De Ley, G.; Van Den Broecke, C.; Van Aken, J.; Struys, M. M. R. F.; Praet, M. M.; Mortier, E. P.

    During endoscopic neurosurgery, direct mechanical stimulation of the brain by the endoscope and increased intracranial pressure (ICP) caused by the continuous rinsing can induce potentially lethal haemodynamic reflexes, brain ischaemia, and excessive fluid resorption. In a newly presented rat model

  5. 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

  6. Adult Neuroblastoma Complicated by Increased Intracranial Pressure: A Case Report and Review of the Literature

    OpenAIRE

    Stevens, Patrick L.; Johnson, Douglas B.; Thompson, Mary Ann; Keedy, Vicki L.; Frangoul, Haydar A.; Snyder, Kristen M.

    2014-01-01

    Neuroblastoma is the third most commonly occurring malignancy of the pediatric population, although it is extremely rare in the adult population. In adults, neuroblastoma is often metastatic and portends an extremely poor overall survival. Our case report documents metastatic neuroblastoma occurring in a healthy 29-year-old woman whose course was complicated by an unusual presentation of elevated intracranial pressures. The patient was treated with systemic chemotherapy, I131 metaiodobenzylgu...

  7. The effect of intracranial pressure on the performance of an aphasic subject: A case history

    Directory of Open Access Journals (Sweden)

    Michelle Shapiro

    1981-11-01

    Full Text Available A battery of tests involving the language modalities of speech, comprehension, reading and writing were administered to an aphasic subject who presented with a predictable fluctuation  in intracranial pressure. Results revealed a consistency in performance in the two situations, across all modalities. The subject's performance  was found  to be of  a concrete nature, demonstrating a cognitive deficit  concomitant with his linguistic impairment.

  8. 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.

  9. Elevated intracranial pressure causes optic nerve and retinal ganglion cell degeneration in mice.

    Science.gov (United States)

    Nusbaum, Derek M; Wu, Samuel M; Frankfort, Benjamin J

    2015-07-01

    The purpose of this study was to develop a novel experimental system for the modulation and measurement of intracranial pressure (ICP), and to use this system to assess the impact of elevated ICP on the optic nerve and retinal ganglion cells (RGCs) in CD1 mice. This system involved surgical implantation of an infusion cannula and a radiowave based pressure monitoring probe through the skull and into the subarachnoid space. The infusion cannula was used to increase ICP, which was measured by the probe and transmitted to a nearby receiver. The system provided robust and consistent ICP waveforms, was well tolerated, and was stable over time. ICP was elevated to approximately 30 mmHg for one week, after which we assessed changes in optic nerve structure with transmission electron microscopy in cross section and RGC numbers with antibody staining in retinal flat mounts. ICP elevation resulted in optic nerve axonal loss and disorganization, as well as RGC soma loss. We conclude that the controlled manipulation of ICP in active, awake mice is possible, despite their small size. Furthermore, ICP elevation results in visual system phenotypes of optic nerve and RGC degeneration, suggesting that this model can be used to study the impact of ICP on the visual system. Potentially, this model can also be used to study the relationship between ICP and IOP, as well diseases impacted by ICP variation such as glaucoma, idiopathic intracranial hypertension, and the spaceflight-related visual impairment intracranial pressure syndrome. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. 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.

  11. 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.

  12. 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.

  13. 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

  14. Antisecretory factor (AF) exerts no effects on intracranial pressure (ICP) waves and ICP in patients with idiopathic normal pressure hydrocephalus and idiopathic intracranial hypertension.

    Science.gov (United States)

    Eide, Per Kristian; Eidsvaag, Vigdis Andersen; Hansson, Hans-Arne

    2014-08-15

    Antisecretory factor (AF) and derivates thereof counteract brain edema and inflammation, and normalize ICP dynamics. The aim of the present study was to assess whether AF normalized the abnormal ICP waves, indicative of impaired intracranial compliance, seen in patients with idiopathic normal pressure hydrocephalus (iNPH) and idiopathic intracranial hypertension (IIH). The hypothesis was that brain swelling contributes to the abnormal ICP waves. The study enrolled patients undergoing diagnostic ICP wave monitoring for either iNPH or IIH. The ICP waves and ICP were recorded continuously before and after oral administration of Salovum® (0.5 g/kg body weight/day divided by three doses), a freeze-dried egg yolk enriched in AF activity. Mean ICP wave amplitude (MWA), mean ICP wave rise time coefficient (MWRTC), and mean ICP were compared before and after Salovum® administration. A total of 10 iNPH patients and 8 IIH patients were included. No significant changes in the ICP wave indices or ICP were seen after Salovum® administration. Neither any significant time-dependent effect was observed. The lack of effect of Salovum® on ICP wave indices and ICP in iNPH and IIH may provide indirect evidence that brain swelling does not play a crucial role in the ICP wave indices or ICP of these conditions. Copyright © 2014 Elsevier B.V. All rights reserved.

  15. 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. Methods......: We analyzed data from all nonshunted patients undergoing a 24-hour ICP monitoring as part of a diagnostic work-up and included patients with no subsequent suspicion of increased ICP and no need for pressure-relieving treatment with a minimum follow-up period of 3 years. Results: From February 2008...

  16. Non-Invasive Intracranial Pressure Estimation During Combined Exposure to CO₂ and Head-Down Tilt.

    Science.gov (United States)

    Kurazumi, Takuya; Ogawa, Yojiro; Yanagida, Ryo; Morisaki, Hiroshi; Iwasaki, Ken-Ichi

    2018-04-01

    Exposure to carbon dioxide (CO2) and cephalad fluid shift are considered factors that affect intracranial pressure (ICP) during spaceflight. Increases in ICP were reported during cephalad fluid shift induced by head-down tilt (HDT), while little is known regarding the effect of additional CO2 during HDT on ICP. Therefore, we tested the hypothesis that this combination increases ICP more than HDT alone. There were 15 healthy male volunteers who underwent 4 types of 10-min interventions consisting of Placebo/Supine (air and supine), CO2/Supine (3% CO2 and supine, CO2 alone), Placebo/HDT (air and -10° HDT, HDT alone), and CO2/HDT (3% CO2 and -10° HDT, combination). Using arterial blood pressure (ABP) and cerebral blood flow velocity waveforms, ICP was estimated noninvasively before and during the four interventions. Two calculation methods were employed. One is based on the signal transformation from ABP to ICP with the intracranial component as a "black box" system (nICP_BB), and the other is based on the equation ICP = ABP - cerebral perfusion pressure, reflecting critical closing pressure (nICP_CrCP). Both nICP_BB and nICP_CrCP significantly increased during Placebo/HDT and CO2/HDT, although there was no statistically significant difference between the nICP indexes of these two interventions. Increases in ICP were observed during both Placebo/HDT and CO2/HDT. Contrary to our hypothesis, the combination of 3% CO2 and -10° HDT did not increase ICP remarkably compared to -10° HDT alone. Therefore, the addition of 3% CO2 is considered to have little effect on increasing ICP during cephalad fluid shift.Kurazumi T, Ogawa Y, Yanagida R, Morisaki H, Iwasaki K. Non-invasive intracranial pressure estimation during combined exposure to CO2 and head-down tilt. Aerosp Med Hum Perform. 2018; 89(4):365-370.

  17. Early Craniectomy Improves Intracranial and Cerebral Perfusion Pressure after Severe Traumatic Brain Injury.

    Science.gov (United States)

    Allen, Casey J; Baldor, Daniel J; Hanna, Mena M; Namias, Nicholas; Bullock, M Ross; Jagid, Jonathan R; Proctor, Kenneth G

    2018-03-01

    After traumatic brain injury, decompressive craniectomy (DC) is a second-tier, late therapy for refractory intracranial hypertension. We hypothesize that early DC, based on CT evidence of intracranial hypertension, improves intracranial pressure (ICP) and cerebral perfusion pressure (CPP). From September 2008 to January 2015, 286 traumatic brain injury patients requiring invasive ICP monitoring at a single Level I trauma center were reviewed. DC and non-DC patients were propensity score matched 1:1, based on demographics, hemodynamics, injury severity score (ISS), Glasgow Coma Scale (GCS), transfusion requirements, and need for vasopressor therapy. Data are presented as M ± SD or median (IQR) and compared at P ≤ 0.05. The study population was 42 ± 17 years, 84 per cent male, ISS = 29 ± 11, GCS = 6(5), length of stay (LOS) = 32(40) days, and 28 per cent mortality. There were 116/286 (41%) DC, of which 105/116 (91%) were performed at the time of ICP placement. For 50 DC propensity matched to 50 non-DC patients, the midline shift was 7(11) versus 0(5) mm (P 20 mm Hg) was 1(10) versus 8(16) (P = 0.017), abnormal CPP (hours < 60 mm Hg) was 0(6) versus 4(9) (P = 0.008), daily minimum CPP (mm Hg) was 67(13) versus 62(17) (P = 0.010), and daily maximum ICP (mm Hg) was 18(9) versus 22(11) (P < 0.001). However, LOS [33(37) versus 25(34) days], mortality (24 versus 30%), and Glasgow Outcome Score Extended [3.0(3.0) versus 3.0(4.0)] did not improve significantly. Early DC for CT evidence of intracranial hypertension decreased abnormal ICP and CPP time and improved ICP and CPP thresholds, but had no obvious effect on the outcome.

  18. Pulsatile flow of cerebrospinal fluid on magnetic resonance images and its relation to intracranial pressure

    International Nuclear Information System (INIS)

    Ohara, Shigeki

    1988-01-01

    In a retrospective study of the magnetic resonance (MR) images of 289 neurosurgical patients, loss of signal intensity (the signal void phenomenon) of cerebrospinal fluid (CSF) in the mesencephalic aqueduct was observed in 77 patients. This signal void phenomenon (SVP) was seen most frequently in patients suffering from communicating hydrocephalus (12 of 14), less frequently in patients with supratentorial tumors (7 of 50), and not at all in patients with noncommunicating hydrocephalus (none of 9). Eight of 19 patients with infratentorial lesions who did not demonstrate the SVP preoperatively, developed it after suboccipital craniectomy. It is known that CSF in the cranial cavity flows toward the spinal CSF space in a to and fro manner in response to the pulsations of the brain. The velocity of this flow is faster in the narrower parts in the ventricular system such as the aqueduct, Monro's foramen and the fourth ventricle. The SVP reflects CSF pulsatile flow forced out of the intracranial space into the intraspinal space by the brain's pulsations. The SVP was observed frequently in the MR images of patients with communicating hydrocephalus who showed normal intracranial mean pressure (mICP) and normal pulse pressure (PP), whereas the SVP was observed rarely in patients with high mICP and high PP, such as those with a supratentorial tumor. The SVP may reflect the capacity of the craniospinal cavity to buffer pressure within it. It may be possible to differentiate normal from increased intracranial pressure by detection of the SVP in CSF in the ventricular system. (author)

  19. Neuro-ophthalmic presentations and treatment of Cryptococcal meningitis-related increased intracranial pressure.

    Science.gov (United States)

    Espino Barros Palau, Angelina; Morgan, Michael L; Foroozan, Rod; Lee, Andrew G

    2014-10-01

    To illustrate three different ophthalmic presentations of cryptococcal meningitis (CM). CM is the most common manifestation of extra-pulmonary cryptococcosis. Intracranial hypertension occurs in up to 75% of patients with CM and is associated with increased mortality. CM can present to the ophthalmologist as vision loss, papilledema, abducens palsy, and/or other cranial neuropathies. We report three cases, two C. neoformans and one C. gattii, highlighting the various CM presentations. The first was a woman immunosuppressed following kidney transplantation in whom idiopathic intracranial hypertension (IIH) was initially suspected. The second was a man immunocompromised by previously undiagnosed HIV/AIDS who presented with signs and symptoms of increased intracranial pressure. The third case is an immunocompetent man with bilateral disc edema and an incomplete macular star diagnosed with presumed neuroretinitis. Further evaluation revealed positive CSF cryptococcal antigen with culture positive for C. gattii. Ophthalmologists should be aware that cryptococcosis can mimic more benign etiologies including IIH and neuroretinitis. Additionally, C. gattii, an emerging organism, can infect immunocompetent patients. In contrast to the typical treatment of increased ICP, serial lumbar punctures are recommended while acetazolamide and surgical CSF shunting may be harmful. Copyright © 2014 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  20. 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.

  1. 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.

  2. Non-invasive Monitoring of Intracranial Pressure Using Transcranial Doppler Ultrasonography: Is It Possible?

    Science.gov (United States)

    Cardim, Danilo; Robba, C; Bohdanowicz, M; Donnelly, J; Cabella, B; Liu, X; Cabeleira, M; Smielewski, P; Schmidt, B; Czosnyka, M

    2016-12-01

    Although intracranial pressure (ICP) is essential to guide management of patients suffering from acute brain diseases, this signal is often neglected outside the neurocritical care environment. This is mainly attributed to the intrinsic risks of the available invasive techniques, which have prevented ICP monitoring in many conditions affecting the intracranial homeostasis, from mild traumatic brain injury to liver encephalopathy. In such scenario, methods for non-invasive monitoring of ICP (nICP) could improve clinical management of these conditions. A review of the literature was performed on PUBMED using the search keywords 'Transcranial Doppler non-invasive intracranial pressure.' Transcranial Doppler (TCD) is a technique primarily aimed at assessing the cerebrovascular dynamics through the cerebral blood flow velocity (FV). Its applicability for nICP assessment emerged from observation that some TCD-derived parameters change during increase of ICP, such as the shape of FV pulse waveform or pulsatility index. Methods were grouped as: based on TCD pulsatility index; aimed at non-invasive estimation of cerebral perfusion pressure and model-based methods. Published studies present with different accuracies, with prediction abilities (AUCs) for detection of ICP ≥20 mmHg ranging from 0.62 to 0.92. This discrepancy could result from inconsistent assessment measures and application in different conditions, from traumatic brain injury to hydrocephalus and stroke. Most of the reports stress a potential advantage of TCD as it provides the possibility to monitor changes of ICP in time. Overall accuracy for TCD-based methods ranges around ±12 mmHg, with a great potential of tracing dynamical changes of ICP in time, particularly those of vasogenic nature.

  3. A trial of intracranial-pressure monitoring in traumatic brain injury.

    Science.gov (United States)

    Chesnut, Randall M; Temkin, Nancy; Carney, Nancy; Dikmen, Sureyya; Rondina, Carlos; Videtta, Walter; Petroni, Gustavo; Lujan, Silvia; Pridgeon, Jim; Barber, Jason; Machamer, Joan; Chaddock, Kelley; Celix, Juanita M; Cherner, Marianna; Hendrix, Terence

    2012-12-27

    Intracranial-pressure monitoring is considered the standard of care for severe traumatic brain injury and is used frequently, but the efficacy of treatment based on monitoring in improving the outcome has not been rigorously assessed. We conducted a multicenter, controlled trial in which 324 patients 13 years of age or older who had severe traumatic brain injury and were being treated in intensive care units (ICUs) in Bolivia or Ecuador were randomly assigned to one of two specific protocols: guidelines-based management in which a protocol for monitoring intraparenchymal intracranial pressure was used (pressure-monitoring group) or a protocol in which treatment was based on imaging and clinical examination (imaging-clinical examination group). The primary outcome was a composite of survival time, impaired consciousness, and functional status at 3 months and 6 months and neuropsychological status at 6 months; neuropsychological status was assessed by an examiner who was unaware of protocol assignment. This composite measure was based on performance across 21 measures of functional and cognitive status and calculated as a percentile (with 0 indicating the worst performance, and 100 the best performance). There was no significant between-group difference in the primary outcome, a composite measure based on percentile performance across 21 measures of functional and cognitive status (score, 56 in the pressure-monitoring group vs. 53 in the imaging-clinical examination group; P=0.49). Six-month mortality was 39% in the pressure-monitoring group and 41% in the imaging-clinical examination group (P=0.60). The median length of stay in the ICU was similar in the two groups (12 days in the pressure-monitoring group and 9 days in the imaging-clinical examination group; P=0.25), although the number of days of brain-specific treatments (e.g., administration of hyperosmolar fluids and the use of hyperventilation) in the ICU was higher in the imaging-clinical examination group

  4. 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.

  5. Finite element model of size, shape and blood pressure on rupture of intracranial saccular aneurysms

    Science.gov (United States)

    Rica Nabong, Jennica; David, Guido

    2017-10-01

    Rupture of intracranial saccular aneurysms is a primary concern for neurologists and patients because it leads to stroke and permanent disability. This paper examines the role of blood pressure, in connection with size of and wall thickness, in the rupture of saccular aneurysms. A bulb-shaped geometry of a saccular aneurysm is obtained from angiographic images of a patient and modeled using Finite Elements based on the principle of virtual work under the Fung stress-strain relationship. The numerical model is subjected to varying levels of systolic blood pressure. Rupture is assumed to occur when the wall stress exceeded its mechanical strength. The results show which sizes of this class of aneurysms are at high risk of rupture for varying levels of blood pressure.

  6. Use of intracranial pressure monitoring in bacterial meningitis: a 10-year follow up on outcome and intracranial pressure versus head CT scans.

    Science.gov (United States)

    Larsen, Lykke; Poulsen, Frantz R; Nielsen, Troels H; Nordström, Carl-Henrik; Schulz, Mette K; Andersen, Åse B

    2017-05-01

    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. A retrospective observational study including patients admitted 1st . January 2005 to 31st . December 2014. Thirty nine patients age 18-89 years were included. All the patients received intensive care with mechanical ventilation, ICP monitoring, sedation, antibiotics and corticosteroids according to current guidelines. Clinical outcome was defined as death during hospitalization or survival at hospital discharge. The most common pathogen was Streptococcus pneumoniae (26; 67%). Thirteen patients died (33%) and neurologic impairment was noted in twenty two (84.6%) surviving patients. In S. pneumoniae cases patients with adverse outcome were significantly older (p = 0.0024) and immunosuppressed (p = 0.034). Lower mean-cerebral perfusion pressure (CPP) was found to correlate with adverse outcome (p = 0.005). Cerebrospinal fluid (CSF) was drained in fourteen patients. Increased ICP (>20 mmHg) was observed in twenty four patients. No significant correlation was found between measured ICP and head CT scans with signs of elevated ICP. Patients with severe meningitis should be admitted to intensive care units and evaluated for ICP monitoring regardless of head CT findings.

  7. Intracranial Blood-Flow Velocity and Pressure Measurements Using an Intra-Arterial Dual-Sensor Guidewire

    NARCIS (Netherlands)

    Ferns, S. P.; Schneiders, J. J.; Siebes, M.; van den Berg, R.; van Bavel, E. T.; Majoie, C. B.

    2010-01-01

    Hemodynamics is thought to play a role in the growth and rupture of intracranial aneurysms. In 4 patients, we obtained local pressure and BFV by using a dual-sensor pressure and Doppler velocity wire within and in vessels surrounding unruptured aneurysms. Local BFVs can serve as boundary conditions

  8. Brain hypoxanthine concentration correlates to lactate/pyruvate ratio but not intracranial pressure in patients with acute liver failure

    DEFF Research Database (Denmark)

    Bjerring, Peter Nissen; Hauerberg, John; Jørgensen, Linda

    2010-01-01

    of hypoxanthine, inosine, and lactate/pyruvate (LP) ratio are increased and correlated in patients with acute liver failure. Furthermore, we expect the purines and L/P ratio to correlate with intracranial pressure (ICP) (positively), and cerebral perfusion pressure (CPP) (negatively)....

  9. Safety and efficacy of combined epidural/general anesthesia during major abdominal surgery in patients with increased intracranial pressure: a cohort study.

    Science.gov (United States)

    Zabolotskikh, Igor; Trembach, Nikita

    2015-05-15

    The increased intracranial pressure can significantly complicate the perioperative period in major abdominal surgery, increasing the risk of complications, the length of recovery from the surgery, worsening the outcome. Epidural anesthesia has become a routine component of abdominal surgery, but its use in patients with increased intracranial pressure remains controversial. The goal of the study was to evaluate the safety and efficacy of epidural anesthesia, according to monitoring of intracranial pressure in patients with increased intracranial pressure. The study includes 65 surgical patients who were routinely undergone the major abdominal surgery under combined epidural/general anesthesia. Depending on the initial ICP all patients were divided into 2 groups: 1 (N group) - patients with the normal intracranial pressure (≤12 mm Hg, n = 35) and 2 (E group) - patients with the elevated intracranial pressure (ICP > 12 mm Hg, n = 30). During the surgery we evaluated ICP, blood pressure, cerebral perfusion pressure (CPP). The parameters of recovery from anesthesia and the effectiveness of postoperative analgesia were also assessed. In N group ICP remained stable. In E group ICP decreased during anesthesia, the overall decline was 40% at the end of the operation (from 15 to 9 mm Hg (P intracranial pressure undergoing elective abdominal surgery under the condition of maintaining the arterial pressure. Its use is not associated with the increase in intracranial pressure during the anesthesia, but it needs an intraoperative monitoring of ICP in order to prevent CPP reduction.

  10. A Comparison of Pharmacologic Therapeutic Agents Used for the Reduction of Intracranial Pressure After Traumatic Brain Injury.

    Science.gov (United States)

    Alnemari, Ahmed M; Krafcik, Brianna M; Mansour, Tarek R; Gaudin, Daniel

    2017-10-01

    In neurotrauma care, a better understanding of treatments after traumatic brain injury (TBI) has led to a significant decrease in morbidity and mortality in this population. TBI represents a significant medical problem, and complications after TBI are associated with the initial injury and postevent intracranial processes such as increased intracranial pressure and brain edema. Consequently, appropriate therapeutic interventions are required to reduce brain tissue damage and improve cerebral perfusion. We present a contemporary review of literature on the use of pharmacologic therapies to reduce intracranial pressure after TBI and a comparison of their efficacy. This review was conducted by PubMed query. Only studies discussing pharmacologic management of patients after TBI were included. This review includes prospective and retrospective studies and includes randomized controlled trials as well as cohort, case-control, observational, and database studies. Systematic literature reviews, meta-analyses, and studies that considered conditions other than TBI or pediatric populations were not included. Review of the literature describing the current pharmacologic treatment for intracranial hypertension after TBI most often discussed the use of hyperosmolar agents such as hypertonic saline and mannitol, sedatives such as fentanyl and propofol, benzodiazepines, and barbiturates. Hypertonic saline is associated with faster resolution of intracranial hypertension and restoration of optimal cerebral hemodynamics, although these advantages did not translate into long-term benefits in morbidity or mortality. In patients refractory to treatment with hyperosmolar therapy, induction of a barbiturate coma can reduce intracranial pressure, although requires close monitoring to prevent adverse events. Current research suggests that the use of hypertonic saline after TBI is the best option for immediate decrease in intracranial pressure. A better understanding of the efficacy of

  11. Chest physiotherapy on intracranial pressure of critically ill patients admitted to the intensive care unit: a systematic review.

    Science.gov (United States)

    Ferreira, Lucas Lima; Valenti, Vitor Engrácia; Vanderlei, Luiz Carlos Marques

    2013-01-01

    To analyze the outcomes of increased or decreased intracranial pressure and/or the decrease in cerebral perfusion pressure resulting from respiratory physiotherapy on critically ill patients admitted to the intensive care unit. Through a systematic review of the literature, clinical trials published between 2002 and 2012 were selected. The search involved the LILACS, SciELO, MedLine and PEDro databases using the keywords "physical therapy", "physiotherapy", "respiratory therapy" and "randomized controlled trials" combined with the keyword "intracranial pressure". In total, five studies, including a total of 164 patients between 25 and 65 years of age, reporting that respiratory physiotherapy maneuvers significantly increased intracranial pressure without changing the cerebral perfusion pressure were included. The articles addressed several techniques including vibration, vibrocompression, tapping, postural drainage, and the endotracheal aspiration maneuver. All patients required invasive mechanical ventilation. Respiratory physiotherapy leads to increased intracranial pressure. Studies suggest that there are no short-term hemodynamic or respiratory repercussions or changes in the cerebral perfusion pressure. However, none of the studies evaluated the clinical outcomes or ensured the safety of the maneuvers.

  12. 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.

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

    Directory of Open Access Journals (Sweden)

    Bendon Charlotte L

    2012-11-01

    Full Text Available Abstract Background 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. Case presentation 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. Conclusion 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.

  14. Monro-Kellie 2.0: The dynamic vascular and venous pathophysiological components of intracranial pressure.

    Science.gov (United States)

    Wilson, Mark H

    2016-08-01

    For 200 years, the 'closed box' analogy of intracranial pressure (ICP) has underpinned neurosurgery and neuro-critical care. Cushing conceptualised the Monro-Kellie doctrine stating that a change in blood, brain or CSF volume resulted in reciprocal changes in one or both of the other two. When not possible, attempts to increase a volume further increase ICP. On this doctrine's "truth or relative untruth" depends many of the critical procedures in the surgery of the central nervous system. However, each volume component may not deserve the equal weighting this static concept implies. The slow production of CSF (0.35 ml/min) is dwarfed by the dynamic blood in and outflow (∼700 ml/min). Neuro-critical care practice focusing on arterial and ICP regulation has been questioned. Failure of venous efferent flow to precisely match arterial afferent flow will yield immediate and dramatic changes in intracranial blood volume and pressure. Interpreting ICP without interrogating its core drivers may be misleading. Multiple clinical conditions and the cerebral effects of altitude and microgravity relate to imbalances in this dynamic rather than ICP per se. This article reviews the Monro-Kellie doctrine, categorises venous outflow limitation conditions, relates physiological mechanisms to clinical conditions and suggests specific management options. © The Author(s) 2016.

  15. 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.

  16. Episodic high irrigation pressure during surgical neuroendoscopy may cause intermittent intracranial circulatory insufficiency.

    Science.gov (United States)

    Fàbregas, N; Valero, R; Carrero, E; Tercero, J; Caral, L; Zavala, E; Ferrer, E

    2001-04-01

    Intermittent high peak pressure values inside the endoscope during neuroendoscopic surgical procedures are associated with postoperative morbidity. Unexpected delay in awakening is the complication most frequently observed by the anesthesiologist as a result of high peak pressure values inside the endoscope. During eight neuroendoscopic procedures the authors continuously monitored cerebral hemodynamic function, using a transcranial doppler (TCD) probe fixed on patients' temporal window. We observed that episodes of high peak pressure values inside the endoscope during neuroendoscopic navigation rinsing periods resulted in changes in the TCD wave profile consistent with "near intracranial circulatory arrestlike" wave. No systemic hemodynamic warning signs accompanied these intermittent episodes of severe decrease in cerebral perfusion pressure. When the rinsing liquid was allowed to escape, the pressure inside the endoscope decreased and the TCD wave immediately returned to its previous value. Neuroendoscopic procedures, although classified as minimally invasive surgery, warrant special monitoring that could alert us to a decrease in cerebral perfusion pressure. Middle cerebral artery TCD recording is a reliable and accurate tool for this purpose.

  17. 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.

  18. Characteristics of intracranial pressure (ICP) waves and ICP in children with treatment-responsive hydrocephalus.

    Science.gov (United States)

    Sæhle, Terje; Eide, Per Kristian

    2015-06-01

    One important goal of modern treatment of pediatric hydrocephalus is to normalize the intracranial pressure (ICP) and ICP volume reserve capacity to optimize normal brain development. Better knowledge of the characteristics of ICP waves/ICP in pediatric hydrocephalus may provide new insight into the mechanisms behind modern hydrocephalus treatment. The aim of the present work was to characterize the ICP waves/ICP in children with either communicating or non-communicating hydrocephalus who improved clinically after surgery. The hydrocephalic children not treated surgically following ICP monitoring served as reference patients. The patient material includes all children with hydrocephalus and no previous surgical treatment who underwent diagnostic ICP wave/ICP monitoring during the period 2002-2011. We retrieved the information about the patients from the patient records and the digitally stored ICP waveforms. The ICP wave characteristics amplitude, rise time and rise time coefficient and the mean ICP were determined in the patients treated surgically for their hydrocephalus. The findings were compared with findings in children not treated surgically after ICP monitoring who served as reference patients. The patient material includes 58 patients. Thirty-one (53%) were treated surgically after ICP monitoring, of whom all improved clinically. As compared to the reference patients, patients treated surgically presented with increased ICP wave amplitudes (MWA) and mean ICP. Alterations were comparable in communicating and non-communicating hydrocephalus. We found no apparent association between the ICP wave/ICP scores and presence of symptoms, indices of ventricular size or age. Children with either communicating or non-communicating hydrocephalus improving clinically after surgery presented with elevated MWA and mean ICP. In particular, the levels of MWA were raised to a magnitude seen when intracranial compliance is impaired. Hence, the present observations may support

  19. Intracranial pressure, brain PCO2, PO2, and pH during hypo- and hyperventilation at constant mean airway pressure in pigs

    NARCIS (Netherlands)

    van Hulst, Robert A.; Hasan, Djo; Lachmann, Burkhard

    2002-01-01

    OBJECTIVE: To evaluate in healthy, non-brain-traumatized animals the effects of hypo- and hyperventilation on intracranial pressure (ICP) and brain carbon dioxide, oxygen, and pH during the use of a ventilatory mode at constant mean airway pressure (MAwP). DESIGN AND SETTING: Prospective animal

  20. 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.

  1. Central Hemodynamics and Intracranial and Cerebral Perfusion Pressures in Acute Cerebral Circulatory Disorders

    Directory of Open Access Journals (Sweden)

    K. V. Lukashev

    2009-01-01

    Full Text Available Objective: to study the central hemodynamics (CH and intracranial and cerebral perfusion pressures (ICP and CPP in acute cerebral circulatory disorders (ACCD and their possible relationships for further development of intensive differential therapy for the detected disorders. Material and methods. Hemodynamic studies using the transpulmonary thermodilu-tion technique, measurements of ICP, calculations of CPP, and currently available X-ray studies were conducted in 18 patients on days 1, 3, 5, and 7 of ACCD. All the patients were found to have essential hypertension and coronary heart disease. Results. In the first 5 days of ACCD, there was a normodynamic type of circulation in hemorrhagic stroke (HS and a hypodynamic type in ischemic stroke (IS. ICP remained at the baseline elevated level in the IS group and increased over time in the HS group. CPP was significantly unchanged. Myocardial dysfunction was detected when there was a significant preload caused by a high postload. In IS, an inverse correlation was found between ICP and global ejection fraction (GEF, cardiac performance index (CPI and on day 7, the correlation was direct. In HS, ICP had a direct correlation with CPI and an inverse correlation with GEF. These changes during treatment failed to progress and were revealed in the presence of brain dislocation, as evidenced by spiral computed tomography. Conclusion. Thus, the pattern of CH disorders depends on the type of ACCD. In the first 5 days of ACCD, a hypokinetic circulatory type is registered in IS and a normokinetic type is in HS. Evolving dislocation of the brain with impaired function of its stem structures due to ICP elevation is one of the causes of central hemodynamic changes. The value of ICP in ACCD is a crucial indicator in the diagnosis of secondary brain damages and determines treatment policy. Key words: acute ischemic attack, intracranial pressure, cerebral perfusion pressure, central hemodynamics, myocardial depression.

  2. Principles of cerebral hemodynamics when intracranial pressure is raised: lessons from the peripheral circulation

    Science.gov (United States)

    Kim, Mi Ok; Adji, Audrey; O’Rourke, Michael F.; Avolio, Alberto P.; Smielewski, Peter; Pickard, John D.; Czosnyka, Marek

    2015-01-01

    Background: The brain is highly vascular and richly perfused, and dependent on continuous flow for normal function. Although confined within the skull, pressure within the brain is usually less than 15 mmHg, and shows small pulsations related to arterial pulse under normal circumstances. Pulsatile arterial hemodynamics in the brain have been studied before, but are still inadequately understood, especially during changes of intracranial pressure (ICP) after head injury. Method: In seeking cohesive explanations, we measured ICP and radial artery pressure (RAP) invasively with high-fidelity manometer systems, together with middle cerebral artery flow velocity (MCAFV) (transcranial Doppler) and central aortic pressure (CAP) generated from RAP, using a generalized transfer function technique, in eight young unconscious, ventilated adults following closed head trauma. We focused on vascular effects of spontaneous rises of ICP (‘plateau waves’). Results: A rise in mean ICP from 29 to 53 mmHg caused no consistent change in pressure outside the cranium, or in heart rate, but ICP pulsations increased in amplitude from 8 to 20 mmHg, and ICP waveform came to resemble that in the aorta. Cerebral perfusion pressure (=central aortic pressure – ICP), which equates with transmural pressure, fell from 61 to 36 mmHg. Mean MCAFV fell from 53 to 40 cm/s, whereas pulsatile MCAFV increased from 77 to 98 cm/s. These significant changes (all P pressure is applied. Conclusion: The findings emphasize importance of reducing ICP, when raised, and on the additional benefits of reducing wave reflection from the lower body. PMID:25764046

  3. 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...

  4. Venous sinus stenting for reduction of intracranial pressure in IIH: a prospective pilot study.

    Science.gov (United States)

    Liu, Kenneth C; Starke, Robert M; Durst, Christopher R; Wang, Tony R; Ding, Dale; Crowley, R Webster; Newman, Steven A

    2017-11-01

    OBJECTIVE Idiopathic intracranial hypertension (IIH) may cause blindness due to elevated intracranial pressure (ICP). Venous sinus stenosis has been identified in select patients, leading to stenting as a potential treatment, but its effects on global ICP have not been completely defined. The purpose of this pilot study was to assess the effects of venous sinus stenting on ICP in a small group of patients with IIH. METHODS Ten patients for whom medical therapy had failed were prospectively followed. Ophthalmological examinations were assessed, and patients with venous sinus stenosis on MR angiography proceeded to catheter angiography, venography with assessment of pressure gradient, and ICP monitoring. Patients with elevated ICP measurements and an elevated pressure gradient across the stenosis were treated with stent placement. RESULTS All patients had elevated venous pressure (mean 39.5 ± 14.9 mm Hg), an elevated gradient across the venous sinus stenosis (30.0 ± 13.2 mm Hg), and elevated ICP (42.2 ± 15.9 mm Hg). Following stent placement, all patients had resolution of the stenosis and gradient (1 ± 1 mm Hg). The ICP values showed an immediate decrease (to a mean of 17.0 ± 8.3 mm Hg), and further decreased overnight (to a mean of 8 ± 4.2 mm Hg). All patients had subjective and objective improvement, and all but one improved during follow-up (median 23.4 months; range 15.7-31.6 months). Two patients developed stent-adjacent stenosis; retreatment abolished the stenosis and gradient in both cases. Patients presenting with papilledema had resolution on follow-up funduscopic imaging and optical coherence tomography (OCT) and improvement on visual field testing. Patients presenting with optic atrophy had optic nerve thinning on follow-up OCT, but improved visual fields. CONCLUSIONS For selected patients with IIH and venous sinus stenosis with an elevated pressure gradient and elevated ICP, venous sinus stenting results in resolution of the venous pressure

  5. Pediatric idiopathic intracranial hypertension - Is the fixed threshold value of elevated LP opening pressure set too high?

    Science.gov (United States)

    Gerstl, Lucia; Schoppe, Nikola; Albers, Lucia; Ertl-Wagner, Birgit; Alperin, Noam; Ehrt, Oliver; Pomschar, Andreas; Landgraf, Mirjam N; Heinen, Florian

    2017-11-01

    Idiopathic intracranial hypertension (IIH) in children is a rare condition of unknown etiology and various clinical presentations. The primary aim of this study was to evaluate if our pediatric IIH study group fulfilled the revised diagnostic criteria for IIH published in 2013, particularly with regard to clinical presentation and threshold value of an elevated lumbar puncture opening pressure. Additionally we investigated the potential utilization of MR-based and fundoscopic methods of estimating intracranial pressure for improved diagnosis. Clinical data were collected retrospectively from twelve pediatric patients diagnosed with IIH between 2008 and 2012 and revised diagnostic criteria were applied. Comparison with non-invasive methods for measuring intracranial pressure, MRI-based measurement (MR-ICP) and venous ophthalmodynamometry was performed. Only four of the twelve children (33%) fulfilled the revised diagnostic criteria for a definite diagnosis of IIH. Regarding noninvasive methods, MR-ICP (n = 6) showed a significantly higher mean of intracranial pressure compared to a healthy age- and sex-matched control group (p = 0.0043). Venous ophthalmodynamometry (n = 4) showed comparable results to invasive lumbar puncture. The revised diagnostic criteria for IIH may be too strict especially in children without papilledema. MR-ICP and venous ophthalmodynamometry are promising complementary procedures for monitoring disease progression and response to treatment. Copyright © 2017 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  6. 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.

  7. The measurement of intracranial pressure and brain displacement due to short-duration dynamic overpressure loading

    Science.gov (United States)

    Iwaskiw, A. S.; Ott, K. A.; Armiger, R. S.; Wickwire, A. C.; Alphonse, V. D.; Voo, L. M.; Carneal, C. M.; Merkle, A. C.

    2018-01-01

    The experimental measurement of biomechanical responses that correlate with blast-induced traumatic brain injury (bTBI) has proven challenging. These data are critical for both the development and validation of computational and physical head models, which are used to quantify the biomechanical response to blast as well as to assess fidelity of injury mitigation strategies, such as personal protective equipment. Therefore, foundational postmortem human surrogate (PMHS) experimental data capturing the biomechanical response are necessary for human model development. Prior studies have measured short-duration pressure transmission to the brain (Kinetic phase), but have failed to reproduce and measure the longer-duration inertial loading that can occur (Kinematic phase). Four fully instrumented PMHS were subjected to short-duration dynamic overpressure in front-facing and rear-facing orientations, where intracranial pressure (ICP), global head kinematics, and brain motion (as measured by high-speed X-ray) with respect to the skull were recorded. Peak ICP results generally increased with increased dose, and a mirrored pressure response was seen when comparing the polarity of frontal bone versus occipital bone ICP sensors. The head kinematics were delayed when compared to the pressure response and showed higher peak angles for front-facing tests as compared to rear-facing. Brain displacements were approximately 2-6 mm, and magnitudes did not change appreciably between front- and rear-facing tests. These data will be used to inform and validate models used to assess bTBI.

  8. 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

  9. Ultrasound as a Noninvasive Method to Assess Changes of Intracranial Volume and Pressure During Simulated Microgravity

    Science.gov (United States)

    Murthy, G.; Yost, W. T.; Ballard, R. E.; Watenpaugh, D. E.; Kawai, Y.; Hargens, A. R.

    1994-01-01

    Headaches are commonly experienced by astronauts in microgravity and by subjects undergoing head-down tilt (simulated microgravity on Earth). Exposure to microgravity probably elevates blood pressure and flow in the head which may increase intracranial volume (ICV) and pressure (ICP) and in turn cause headache. Due to the slightly compliant nature of the cranial vault and the encasement of brain and its vasculature within this vault, any increase of ICV will increase ICP and slightly distend the cranium. Previous studies document perivascular edema and increased ICP in rhesus monkeys during head-down tilt. Elevated ICP has also been reported in humans during head-down tilt. ICP measurements in healthy humans are rare because of the invasiveness of currently-available measurement techniques. Therefore, we proposed a noninvasive ultrasound technique to assess changes of ICV and JCP. The ultrasound principle is based on compliance of the cranial vault. A 450 kHz ultrasound stimulus is transmitted through the cranium by a transducer every 7.5-10 msec. The ultrasound wave enters the brain tissue, reflects off the opposite side of the cranium and is received by the same transducer. The detected wave is compared for phase quadrature (90 deg.to transmitted wave). Because the electronic circuitry of the device maintains a 90 deg. phase (phi), any alterations in the detected wave caused by an increase of ICV and ICP will be reflected as a change in the wave frequency. Phase shift is directly proportional to path length of the wave, DELTA x, which is expressed as DELTA x = phi lambda/2 pi where lambda is wavelength. Elevated ICV and ICP expand the cranial vault and increase path length of the wave (a measure of intracranial distance). Increased path length equals reduced frequency of the detected wave. Reduced frequency is then related to elevated ICP. This technique has potential uses for ICP studies of astronauts in space and head trauma patients on Earth.

  10. Invasive intracranial pressure monitoring is a useful adjunct in the management of severe hepatic encephalopathy associated with pediatric acute liver failure.

    Science.gov (United States)

    Kamat, Pradip; Kunde, Sachin; Vos, Miriam; Vats, Atul; Gupta, Nitika; Heffron, Thomas; Romero, Rene; Fortenberry, James D

    2012-01-01

    Pediatric acute liver failure is often accompanied by hepatic encephalopathy, cerebral edema, and raised intracranial pressure. Elevated intracranial pressure can be managed more effectively with intracranial monitoring, but acute-liver-failure-associated coagulopathy is often considered a contraindication for invasive monitoring due to risk for intracranial bleeding. We reviewed our experience with use of early intracranial pressure monitoring in acute liver failure in children listed for liver transplantation. Retrospective review of all intubated pediatric acute liver failure patients with grade III and grade IV encephalopathy requiring intracranial pressure monitoring and evaluated for potential liver transplant who were identified from an institutional liver transplant patient database from 1999 to 2009. None. A total of 14 patients were identified who met the inclusion criteria. Their ages ranged from 7 months to 20 yrs. Diagnoses of acute liver failure were infectious (three), drug-induced (seven), autoimmune hepatitis (two), and indeterminate (two). Grade III and IV encephalopathy was seen in ten (71%) and four (29%) patients, respectively. Computed tomography scans before intracranial pressure monitor placement showed cerebral edema in five (35.7%) patients. Before intracranial pressure monitor placement, fresh frozen plasma, vitamin K, and activated recombinant factor VIIa were given to all 14 patients, with significant improvement in coagulopathy (p liver transplant, with 100% surviving neurologically intact. Four of 14 (28%) patients had spontaneous recovery without liver transplant. Two of 14 (14%) patients died due to multiple organ failure before transplant. One patient had a small 9-mm intracranial hemorrhage but survived after receiving a liver transplant. No patient developed intracranial infection. In our series of patients, intracranial pressure monitoring had a low complication rate and was associated with a high survival rate despite severe

  11. 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.

  12. 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

  13. Novel methods to predict increased intracranial pressure during intensive care and long-term neurologic outcome after traumatic brain injury: development and validation in a multicenter dataset.

    Science.gov (United States)

    Güiza, Fabian; Depreitere, Bart; Piper, Ian; Van den Berghe, Greet; Meyfroidt, Geert

    2013-02-01

    Intracranial pressure monitoring is standard of care after severe traumatic brain injury. Episodes of increased intracranial pressure are secondary injuries associated with poor outcome. We developed a model to predict increased intracranial pressure episodes 30 mins in advance, by using the dynamic characteristics of continuous intracranial pressure and mean arterial pressure monitoring. In addition, we hypothesized that performance of current models to predict long-term neurologic outcome could be substantially improved by adding dynamic characteristics of continuous intracranial pressure and mean arterial pressure monitoring during the first 24 hrs in the ICU. Prognostic modeling. Noninterventional, observational, retrospective study. The Brain Monitoring with Information Technology dataset consisted of 264 traumatic brain injury patients admitted to 22 neuro-ICUs from 11 European countries. None. Predictive models were built with multivariate logistic regression and Gaussian processes, a machine learning technique. Predictive attributes were Corticosteroid Randomisation After Significant Head Injury-basic and International Mission for Prognosis and Clinical Trial design in TBI-core predictors, together with time-series summary statistics of minute-by-minute mean arterial pressure and intracranial pressure. Increased intracranial pressure episodes could be predicted 30 mins ahead with good calibration (Hosmer-Lemeshow p value 0.12, calibration slope 1.02, calibration-in-the-large -0.02) and discrimination (area under the receiver operating curve = 0.87) on an external validation dataset. Models for prediction of poor neurologic outcome at six months (Glasgow Outcome Score 1-2) based only on static admission data had 0.72 area under the receiver operating curve; adding dynamic information of intracranial pressure and mean arterial pressure during the first 24 hrs increased performance to 0.90. Similarly, prediction of Glasgow Outcome Score 1-3 was improved from 0

  14. Intraoperative pre- and post-craniofacial reconstruction intracranial pressure (ICP) monitoring in children with craniosynostosis.

    Science.gov (United States)

    Yokote, Akiyoshi; Aihara, Yasuo; Eguchi, Seiichiro; Okada, Yoshikazu

    2013-08-01

    One of the goals of cranial vault expansion performed in patients with craniosynostosis (CS) is to reduce the harmful effects associated with elevated intracranial pressure (ICP). Until now, clear guidelines on when cranial vault expansion should take place have not been established except in unacceptable cosmetic deformities. This paper illustrates the potential benefit of ICP monitoring in determining the time of surgery. The ICP of six patients (ranging from 7 months to 8 years) was measured before and after surgery. For the first time, we regulated end-tidal carbon dioxide, the position and movements, the level of sedation and the monitoring site of our patients under anesthesia to report accurate ICP readings. The mean pre- and postoperative ICPs were 14.7 and 4.2 mmHg, respectively. Pressure sensor was placed through a burr hole under general anesthesia and remained through all stages of recording. Though ICP monitoring has been reported before, the physiological fluctuations of ICP and patient's condition affected results. Under our ICP monitoring protocol, the six-patient study represents a suggestion to standardize ICP measurements under certain conditions in order to improve the reproducibility of ICP monitoring and therefore establish the need for optimal timing of cranial vault expansion in pediatrics. Although we cannot clearly define the indications and establish normal pediatric ICP values from the result of this study because of the small number of cases and some other limitations, this is a new approach to define ICP increase as a potential indication for surgery in CS.

  15. Intracranial Pressure Monitoring: Invasive versus Non-Invasive Methods—A Review

    Science.gov (United States)

    Raboel, P. H.; Bartek, J.; Andresen, M.; Bellander, B. M.; Romner, B.

    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 as well as assess whether noninvasive techniques (transcranial Doppler, tympanic membrane displacement, optic nerve sheath diameter, CT scan/MRI and fundoscopy) can be used as reliable alternatives to the invasive techniques (ventriculostomy and microtransducers). Ventriculostomy is considered the gold standard in terms of accurate measurement of pressure, although microtransducers generally are just as accurate. Both invasive techniques are associated with a minor risk of complications such as hemorrhage and infection. Furthermore, zero drift is a problem with selected microtransducers. The non-invasive techniques are without the invasive methods' risk of complication, but fail to measure ICP accurately enough to be used as routine alternatives to invasive measurement. We conclude that invasive measurement is currently the only option for accurate measurement of ICP. PMID:22720148

  16. Effects and Clinical Characteristics of Intracranial Pressure Monitoring-Targeted Management for Subsets of Traumatic Brain Injury: An Observational Multicenter Study.

    Science.gov (United States)

    Yuan, Qiang; Wu, Xing; Yu, Jian; Sun, Yirui; Li, Zhiqi; Du, Zhuoying; Mao, Ying; Zhou, Liangfu; Hu, Jin

    2015-07-01

    To evaluate the efficacy of traumatic brain injury management guided by intracranial pressure monitoring and to explore the specific subgroups for which intracranial pressure monitoring might be significantly associated with improved outcomes based on a classification of the various traumatic brain injury pathophysiologies using the clinical features and CT scans. Retrospective observational multicenter study. Twenty-two hospitals (16 level I trauma centers and six level II trauma centers) in nine provinces in China. Moderate or severe traumatic brain injury patients who were more than 14 years old. Intracranial pressure monitoring. All data were collected by physicians from medical records. The 6-month mortality and favorable outcome were assessed with the Glasgow Outcome Scale Extended score. An intracranial pressure monitor was inserted into 838 patients (58.1%). The mean duration of intracranial pressure monitoring was 4.44 ± 3.65 days. The significant predictors of intracranial pressure monitoring included the mechanism of injury, a Glasgow Coma Scale score of 9-12 at admission that dropped to a score of 3-8 within 24 hours after injury, a Marshall CT classification of III-IV, the presence of a major extracranial injury, subdural hematoma, intraparenchymal lesions, trauma center level, and intracranial pressure monitoring utilization of hospital. The intracranial pressure monitoring and no intracranial pressure monitoring groups did not significantly differ in terms of complications. For the total sample, the placement of intracranial pressure monitoring was not associated with either 6-month mortality (16.9% vs 20.5%; p = 0.086) or 6-month unfavorable outcome (49.4% vs 45.8%; p = 0.175). For patients with a Glasgow Coma Scale score of 3-8 at admission, intracranial pressure monitoring was also not significantly associated with 6-month mortality (20.9% vs 26.0%; p = 0.053) or an unfavorable outcome (56.9% vs 55.5%; p = 0.646). Multivariate logistic

  17. 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...

  18. Fast diffuse correlation spectroscopy (DCS) for non-invasive measurement of intracranial pressure (ICP) (Conference Presentation)

    Science.gov (United States)

    Farzam, Parisa; Sutin, Jason; Wu, Kuan-Cheng; Zimmermann, Bernhard B.; Tamborini, Davide; Dubb, Jay; Boas, David A.; Franceschini, Maria Angela

    2017-02-01

    Intracranial pressure (ICP) monitoring has a key role in the management of neurosurgical and neurological injuries. Currently, the standard clinical monitoring of ICP requires an invasive transducer into the parenchymal tissue or the brain ventricle, with possibility of complications such as hemorrhage and infection. A non-invasive method for measuring ICP, would be highly preferable, as it would allow clinicians to promptly monitor ICP during transport and allow for monitoring in a larger number of patients. We have introduced diffuse correlation spectroscopy (DCS) as a non-invasive ICP monitor by fast measurement of pulsatile cerebral blood flow (CBF). The method is similar to Transcranial Doppler ultrasound (TCD), which derives ICP from the amplitude of the pulsatile cerebral blood flow velocity, with respect to the amplitude of the pulsatile arterial blood pressure. We believe DCS measurement is superior indicator of ICP than TCD estimation because DCS directly measures blood flow, not blood flow velocity, and the small cortical vessels measured by DCS are more susceptible to transmural pressure changes than the large vessels. For fast DCS measurements to recover pulsatile CBF we have developed a custom high-power long-coherent laser and a strategy for delivering it to the tissue within ANSI standards. We have also developed a custom FPGA-based correlator board, which facilitates DCS data acquisitions at 50-100 Hz. We have tested the feasibility of measuring pulsatile CBF and deriving ICP in two challenging scenarios: humans and rats. SNR is low in human adults due to large optode distances. It is similarly low in rats because the fast heart rate in this setting requires a high repetition rate.

  19. Lumbar catheter for monitoring of intracranial pressure in patients with post-hemorrhagic communicating hydrocephalus.

    Science.gov (United States)

    Speck, Verena; Staykov, Dimitre; Huttner, Hagen B; Sauer, Roland; Schwab, Stefan; Bardutzky, Juergen

    2011-04-01

    We investigated the feasibility and accuracy of intracranial pressure (ICP)-measurement by lumbar drainage (LD) catheter in patients with post-hemorrhagic communicating hydrocephalus (PHCH). Patients with subarachnoid hemorrhage (SAH, n = 21) or spontaneous ganglionic hemorrhage (ICH, n = 22) with ventricular involvement and the need for external ventricular drainage (EVD) due to acute hydrocephalus were included. When EVD weaning was not feasible due to persistent hydrocephalus, an additional LD was placed, after which EVD was clamped off. During this overlap period, patients underwent simultaneous pressure recording via EVD ("EVD-ICP") and LD ("LD-ICP"). Testing included manual compression of the jugular veins and body-posture changes from supine to 30° position. After EVD removal, we evaluated sensitivity and specificity of ICP-rise >20 mmHg during continuous monitoring via LD for the detection of persistent PHCH using additional evaluation with computed tomography (CT). A total of 1,806 measurements were performed in 43 patients. "LD-ICP" was strongly correlated to "EVD-ICP", with determination coefficients R(2) for the baseline measurements and each of the maneuvers ranging from 0.95-0.99, and slopes ranging 0.96-1.01. Sensitivity of "LD-ICP" >20 mmHg for detection of persistent PHCH as compared to CT was 81% and specificity was 100%. Two patients with severe SAH developed reversible signs of herniation after gradually increasing differences between "LD-ICP" and "EVD-ICP" indicated a cranio-spinal pressure gradient, likely due to cerebrospinal fluid overdrainage via LD. ICP measured via LD highly and reliably correlated to ICP measured via EVD in patients with PHCH.

  20. Intrahospital Transfer of Patients with Traumatic Brain Injury: Increase in Intracranial Pressure.

    Science.gov (United States)

    Trofimov, Alex; Kalentiev, George; Yuriev, Michail; Pavlov, Vladislav; Grigoryeva, Vera

    2016-01-01

    To assess the dynamic of intracranial pressure (ICP), cerebral perfusion pressure (CPP), and dynamic pressure reactivity index (PRx) during intrahospital transport. There were 33 comatose patients with severe traumatic brain injury (TBI). The mean age was 36.3 ± 4.8 years (range 19-45 years), and there were 17 men and 16 women. The median Glasgow Coma Scale score at admission was 6.2 ± 0.7. Computed tomography (CT) included native CT, perfusion CT, and CT angiography. The mean CPPs before and after the CT scans were 95.9 ± 10.7 and 81.5 ± 12.5 mmHg respectively. The mean ICP before transport was 19.98 ± 5.3 mmHg (minimum 11.7; maximum 51.7). It was statistically significantly lower (p < 0.001) than during the transfer (26.1 ± 13.5 mmHg). During the period described all patients had increased ICP, especially during vertical movement in an elevator. During horizontal movement on the floor ICP remained higher (p < 0.05). The mean dynamic PRx before and after intrahospital transport was 0.23 ± 0.14 and 0.52 ± 0.04, respectively (p < 0.001). Average duration of the transfer and CT study was 15.3 ± 3.4 min. Intrahospital transport of patients with TBI may lead to a significant increase in ICP, dynamic PRx, and decreased CPP. The results suppose that the decision to perform brain CT in comatose patients with TBI should be carefully considered by clinicians.

  1. 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.

  2. Long-term Response of Cerebrospinal Fluid Pressure in Patients with Idiopathic Intracranial Hypertension - A Prospective Observational Study.

    Science.gov (United States)

    Gafoor, V Abdul; Smita, B; Jose, James

    2017-01-01

    Idiopathic intracranial hypertension (IIH) is increased intracranial pressure (ICP) with normal cerebrospinal fluid (CSF) contents, in the absence of an intracranial mass, hydrocephalus, or other identifiable causes. The current knowledge of the treatment outcome of IIH is limited, and the data on the natural history of this entity are scant. The objective of the study is to study the treatment response of IIH by serially measuring the CSF opening pressure and to delineate the factors influencing the same. A prospective observational study in a cohort of fifty patients with IIH in whom CSF opening pressure was serially measured at pre-specified intervals. The mean CSF opening pressure at baseline was 302.4 ± 51.69 mm of H 2 O (range: 220-410). Even though a higher body mass index (BMI) showed a trend toward a higher CSF opening pressure, the association was not significant ( P = 0.168). However, the age of the patient had a significant negative correlation with the CSF pressure ( P = 0.006). The maximum reduction in CSF pressure occurred in the first 3 months of treatment, and thereafter it plateaued. Remission was attained in 12 (24%) patients. BMI had the strongest association with remission ( P = 0.001). In patients with IIH, treatment response is strongly related to BMI. However, patients with normal BMI are also shown to relapse and hence should have continuous, long-term follow-up. The reduction in CSF pressure attained in the first 3 months could reflect the long-term response to treatment.

  3. Efficacy and Safety of Continuous Micro-Pump Infusion of 3% Hypertonic Saline combined with Furosemide to Control Elevated Intracranial Pressure.

    Science.gov (United States)

    Li, Yuqian; Li, Zhihong; Li, Min; Yang, Yanlong; Wang, Bao; Gao, Li; Zhang, Xingye; Cheng, Hongyu; Fang, Wei; Zhao, Bo; Wang, Boliang; Gao, Guodong; Li, Lihong

    2015-06-17

    Elevated intracranial pressure is one of the most common problems in patients with diverse intracranial disorders, leading to increased morbidity and mortality. Effective management for increased intracranial pressure is based mainly on surgical and medical techniques with hyperosmolar therapy as one of the core medical treatments. The study aimed to explore the effects of continuous micro-pump infusions of 3% hypertonic saline combined with furosemide on intracranial pressure control. We analyzed data on 56 eligible participants with intracranial pressure >20 mmHg from March 2013 to July 2014. The target was to increase and maintain plasma sodium to a level between 145 and 155 mmol/L and osmolarity to a level of 310 to 320 mOsmol/kg. Plasma sodium levels significantly increased from 138±5 mmol/L at admission to 151±3 mmol/L at 24 h (PIntracranial pressure significantly decreased from 32±7 mmHg to 15±6 mmHg at 24 h (Ppressure, mean arterial pressure, and Glasgow Coma Scale slightly increased. However, these changes were not statistically significant. Continuous infusion of 3% hypertonic saline + furosemide is effective and safe for intracranial pressure control.

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

    OpenAIRE

    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

    2016-01-01

    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 follo...

  5. Fuzzy logic control for intracranial pressure via continuous propofol sedation in a neurosurgical intensive care unit.

    Science.gov (United States)

    Huang, Sheng-Jean; Shieh, Jiann-Shing; Fu, Mu; Kao, Ming-Chien

    2006-09-01

    The major goal of this paper is to provide automatically continuous propofol sedation for patients with severe head injury, unconsciousness, and mechanical ventilation in order to reduce the effect of agitation on intracranial pressure (ICP) using fuzzy logic control in a neurosurgical intensive care unit (NICU). Seventeen patients were divided into three groups in which control was provided with three different controllers. Experimental control periods were of 60min duration in all cases. Group A used a conventional rule-based controller (RBC), Group B a fuzzy logic controller (FLC), and Group C a self-organizing fuzzy logic controller (SOFLC). The performance of the controllers was analyzed by ICP pattern of sedation. The ICP pattern of errors was analyzed for mean and root mean square deviation (RMSD) for the entire duration of control (i.e., 1h). The results indicate that FLC can easily mimic the rule-base of human experts (i.e., neurosurgeons) to achieve stable sedation similar to the RBC group. Furthermore, the results also show that a SOFLC can provide more stable sedation of ICP pattern because it can modify the fuzzy rule-base to compensate for inter-patient variations.

  6. 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.

  7. The effect of increased intracranial pressure on vestibular evoked myogenic potentials in superior canal dehiscence syndrome.

    Science.gov (United States)

    Janky, Kristen L; Zuniga, M Geraldine; Schubert, Michael C; Carey, John P

    2015-04-01

    To determine if vestibular evoked myogenic potential (VEMP) responses change during inversion in patients with superior canal dehiscence syndrome (SCDS) compared to controls. Sixteen subjects with SCDS (mean: 43, range 30-57 years) and 15 age-matched, healthy subjects (mean: 41, range 22-57 years) completed cervical VEMP (cVEMP) in response to air conduction click stimuli and ocular VEMP (oVEMP) in response to air conduction 500 Hz tone burst stimuli and midline tap stimulation. All VEMP testing was completed in semi-recumbent and inverted conditions. SCDS ears demonstrated significantly larger oVEMP peak-to-peak amplitudes in comparison to normal ears in semi-recumbency. While corrected cVEMP peak-to-peak amplitudes were larger in SCDS ears; this did not reach significance in our sample. Overall, there was not a differential change in o- or cVEMP amplitude with inversion between SCDS and normal subjects. Postural-induced changes in o- and cVEMP responses were measured in the steady state regardless of whether the labyrinth was intact or dehiscent. VEMP responses are blunted during inversion. Although steady-state measurements of VEMPs during inversion do not increase diagnostic accuracy for SCDS, the findings suggest that inversion may provide more general insights into the equilibration of pressures between intracranial and intralabyrinthine fluids. Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  8. Elevated Intracranial Pressure and Cerebral Edema following Permanent MCA Occlusion in an Ovine Model

    Science.gov (United States)

    Wells, Adam J.; Vink, Robert; Helps, Stephen C.; Knox, Steven J.; Blumbergs, Peter C.; Turner, Renée J.

    2015-01-01

    Introduction Malignant middle cerebral artery (MCA) stroke has a disproportionately high mortality due to the rapid development of refractory space-occupying cerebral edema. Animal models are essential in developing successful anti-edema therapies; however to date poor clinical translation has been associated with the predominately used rodent models. As such, large animal gyrencephalic models of stroke are urgently needed. The aim of the study was to characterize the intracranial pressure (ICP) response to MCA occlusion in our recently developed ovine stroke model. Materials and Methods 30 adult female Merino sheep (n = 8–12/gp) were randomized to sham surgery, temporary or permanent proximal MCA occlusion. ICP and brain tissue oxygen were monitored for 24 hours under general anesthesia. MRI, infarct volume with triphenyltetrazolium chloride (TTC) staining and histology were performed. Results No increase in ICP, radiological evidence of ischemia within the MCA territory but without space-occupying edema, and TTC infarct volumes of 7.9+/-5.1% were seen with temporary MCAO. Permanent MCAO resulted in significantly elevated ICP, accompanied by 30% mortality, radiological evidence of space-occupying cerebral edema and TTC infarct volumes of 27.4+/-6.4%. Conclusions Permanent proximal MCAO in the sheep results in space-occupying cerebral edema, raised ICP and mortality similar to human malignant MCA stroke. This animal model may prove useful for pre-clinical testing of anti-edema therapies that have shown promise in rodent studies. PMID:26121036

  9. Pulsed Electromagnetic Field (PEMF) Mitigates High Intracranial Pressure (ICP) Induced Microvascular Shunting (MVS) in Rats.

    Science.gov (United States)

    Bragin, Denis E; Bragina, Olga A; Hagberg, Sean; Nemoto, Edwin M

    2018-01-01

    High-frequency pulsed electromagnetic field (PEMF) stimulation is an emerging noninvasive therapy that we have shown increases cerebral blood flow (CBF) and tissue oxygenation in the healthy rat brain. In this work, we tested the effect of PEMF on the brain at high intracranial pressure (ICP). We previously showed that high ICP in rats caused a transition from capillary (CAP) to non-nutritive microvascular shunt (MVS) flow, tissue hypoxia and increased blood brain barrier (BBB) permeability. Using in vivo two-photon laser scanning microscopy (2PLSM) over the rat parietal cortex, and studied the effects of PEMF on microvascular blood flow velocity, tissue oxygenation (NADH autofluorescence), BBB permeability and neuronal necrosis during 4 h of elevated ICP to 30 mmHg. PEMF significantly dilated arterioles, increased capillary blood flow velocity and reduced MVS/capillary ratio compared to sham-treated animals. These effects led to a significant decrease in tissue hypoxia, BBB degradation and neuronal necrosis. PEMF attenuates high ICP-induced pathological microcirculatory changes, tissue hypoxia, BBB degradation and neuronal necrosis.

  10. Elevated Intracranial Pressure and Cerebral Edema following Permanent MCA Occlusion in an Ovine Model.

    Science.gov (United States)

    Wells, Adam J; Vink, Robert; Helps, Stephen C; Knox, Steven J; Blumbergs, Peter C; Turner, Renée J

    2015-01-01

    Malignant middle cerebral artery (MCA) stroke has a disproportionately high mortality due to the rapid development of refractory space-occupying cerebral edema. Animal models are essential in developing successful anti-edema therapies; however to date poor clinical translation has been associated with the predominately used rodent models. As such, large animal gyrencephalic models of stroke are urgently needed. The aim of the study was to characterize the intracranial pressure (ICP) response to MCA occlusion in our recently developed ovine stroke model. 30 adult female Merino sheep (n = 8-12/gp) were randomized to sham surgery, temporary or permanent proximal MCA occlusion. ICP and brain tissue oxygen were monitored for 24 hours under general anesthesia. MRI, infarct volume with triphenyltetrazolium chloride (TTC) staining and histology were performed. No increase in ICP, radiological evidence of ischemia within the MCA territory but without space-occupying edema, and TTC infarct volumes of 7.9+/-5.1% were seen with temporary MCAO. Permanent MCAO resulted in significantly elevated ICP, accompanied by 30% mortality, radiological evidence of space-occupying cerebral edema and TTC infarct volumes of 27.4+/-6.4%. Permanent proximal MCAO in the sheep results in space-occupying cerebral edema, raised ICP and mortality similar to human malignant MCA stroke. This animal model may prove useful for pre-clinical testing of anti-edema therapies that have shown promise in rodent studies.

  11. Imaging Modalities Relevant to Intracranial Pressure Assessment in Astronauts: A Case-Based Discussion

    Science.gov (United States)

    Sargsyan, Ashot E.; Kramer, Larry A.; Hamilton, Douglas R.; Hamilton, Douglas R.; Fogarty, Jennifer; Polk, J. D.

    2010-01-01

    Introduction: Intracranial pressure (ICP) elevation has been inferred or documented in a number of space crewmembers. Recent advances in noninvasive imaging technology offer new possibilities for ICP assessment. Most International Space Station (ISS) partner agencies have adopted a battery of occupational health monitoring tests including magnetic resonance imaging (MRI) pre- and postflight, and high-resolution sonography of the orbital structures in all mission phases including during flight. We hypothesize that joint consideration of data from the two techniques has the potential to improve quality and continuity of crewmember monitoring and care. Methods: Specially designed MRI and sonographic protocols were used to image eyes and optic nerves (ON) including the meningeal sheaths. Specific crewmembers multi-modality imaging data were analyzed to identify points of mutual validation as well as unique features of complementary nature. Results and Conclusion: Magnetic resonance imaging (MRI) and high-resolution sonography are both tomographic methods, however images obtained by the two modalities are based on different physical phenomena and use different acquisition principles. Consideration of the images acquired by these two modalities allows cross-validating findings related to the volume and fluid content of the ON subarachnoid space, shape of the globe, and other anatomical features of the orbit. Each of the imaging modalities also has unique advantages, making them complementary techniques.

  12. Advances in Intracranial Pressure Monitoring and Its Significance in Managing Traumatic Brain Injury

    Science.gov (United States)

    Kawoos, Usmah; McCarron, Richard M.; Auker, Charles R.; Chavko, Mikulas

    2015-01-01

    Intracranial pressure (ICP) measurements are essential in evaluation and treatment of neurological disorders such as subarachnoid and intracerebral hemorrhage, ischemic stroke, hydrocephalus, meningitis/encephalitis, and traumatic brain injury (TBI). The techniques of ICP monitoring have evolved from invasive to non-invasive—with both limitations and advantages. Some limitations of the invasive methods include short-term monitoring, risk of infection, restricted mobility of the subject, etc. The invasiveness of a method limits the frequency of ICP evaluation in neurological conditions like hydrocephalus, thus hampering the long-term care of patients with compromised ICP. Thus, there has been substantial interest in developing noninvasive techniques for assessment of ICP. Several approaches were reported, although none seem to provide a complete solution due to inaccuracy. ICP measurements are fundamental for immediate care of TBI patients in the acute stages of severe TBI injury. In severe TBI, elevated ICP is associated with mortality or poor clinical outcome. ICP monitoring in conjunction with other neurological monitoring can aid in understanding the pathophysiology of brain damage. This review article presents: (a) the significance of ICP monitoring; (b) ICP monitoring methods (invasive and non-invasive); and (c) the role of ICP monitoring in the management of brain damage, especially TBI. PMID:26690122

  13. 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.

  14. The pathophysiology of chronic noncommunicating hydrocephalus: lessons from continuous intracranial pressure monitoring and ventricular infusion testing.

    Science.gov (United States)

    Eide, Per Kristian

    2017-08-11

    OBJECTIVE The pathophysiology of chronic noncommunicating hydrocephalus (ncHC) is poorly understood. This present study explored whether lessons about the pathophysiology of this clinical entity might be retrieved from results of overnight monitoring of pulsatile and static intracranial pressure (ICP) and ventricular infusion testing. METHODS The study cohort included adult patients (> 20 years of age) with chronic ncHC due to aqueductal stenosis in whom symptoms had lasted a minimum of 6 months. A reference cohort consisted of age- and sex-matched patients managed for communicating HC (cHC). Information about symptoms and clinical improvement following surgery was retrieved from a quality register, and results of overnight ICP recordings and ventricular infusion testing were retrieved from the hospital ICP database. RESULTS The cohort with ncHC consisted of 61 patients of whom 6 (10%) were managed conservatively, 34 (56%) by endoscopic third ventriculostomy (ETV), and 21 (34%) using ETV and subsequent shunt surgery. In patients responding to surgery, pulsatile ICP (mean ICP wave amplitude) was significantly increased to a similar magnitude in patients with ncHC and the reference cohort (cHC). Furthermore, intracranial compliance (ICC) was reduced in clinical responders. The results of ventricular infusion testing provided evidence that patients responding to ETV have impaired ventricular CSF absorption, while those requiring shunt placement after ETV present with impaired CSF absorption both in the intraventricular and extraventricular compartments. CONCLUSIONS The study may provide some lessons about the pathophysiology of chronic ncHC. First, increased pulsatile ICP and impaired ICC characterize patients with chronic ncHC who respond clinically to CSF diversion surgery, even though static ICP is not increased. Second, in patients responding clinically to ETV, impaired ventricular CSF absorption may be a key factor. Patients requiring shunt placement for clinical

  15. Intracranial Pressure Increases During Rewarming Period After Mild Therapeutic Hypothermia in Postcardiac Arrest Patients.

    Science.gov (United States)

    Naito, Hiromichi; Isotani, Eiji; Callaway, Clifton W; Hagioka, Shingo; Morimoto, Naoki

    2016-12-01

    Elevation of intracranial pressure (ICP) may worsen brain injury and neurological outcome. Studies on the use of therapeutic hypothermia (TH) for traumatic brain injury suggests that rapid rewarming from TH is associated with elevated ICP and poorer outcomes. However, few studies describe the time course of ICP changes during TH/rewarming after cardiac arrest (CA). In this study, we observed the changes in ICP during mild TH and rewarming after CA. Secondarily, we examined whether ICP is related to outcome. We studied comatose patients resuscitated from CA, who were treated with TH and who had ICP monitored. Target core temperature was 34°C for 24 h and target rewarming rate was 0.25°C/h. ICP and cerebral perfusion pressure (CPP) were monitored during the period. Outcome was rated as cerebral performance category. In nine patients, ICP increased during TH and rewarming (6.0 [4.0-9.0] mmHg to 16.0 [12.0-26.0] mmHg, p = 0.008). CPP did not change during the period (83.3 [80.1-91.0] mmHg to 74.3 [52.0-87.3] mmHg). Higher ICP was associated with worse outcomes (p = 0.009). All the cases with ICP >25 mmHg or CPP <40 mmHg died. Major ICP increment was observed during the rewarming period, although, some increase of ICP occurred even during the mild TH. ICP increment was higher in patients with worse outcomes.

  16. 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.

  17. The effect of baseline pressure errors on an intracranial pressure-derived index: results of a prospective observational study

    Science.gov (United States)

    2014-01-01

    Background In order to characterize the intracranial pressure-volume reserve capacity, the correlation coefficient (R) between the ICP wave amplitude (A) and the mean ICP level (P), the RAP index, has been used to improve the diagnostic value of ICP monitoring. Baseline pressure errors (BPEs), caused by spontaneous shifts or drifts in baseline pressure, cause erroneous readings of mean ICP. Consequently, BPEs could also affect ICP indices such as the RAP where in the mean ICP is incorporated. Methods A prospective, observational study was carried out on patients with aneurysmal subarachnoid hemorrhage (aSAH) undergoing ICP monitoring as part of their surveillance. Via the same burr hole in the scull, two separate ICP sensors were placed close to each other. For each consecutive 6-sec time window, the dynamic mean ICP wave amplitude (MWA; measure of the amplitude of the single pressure waves) and the static mean ICP, were computed. The RAP index was computed as the Pearson correlation coefficient between the MWA and the mean ICP for 40 6-sec time windows, i.e. every subsequent 4-min period (method 1). We compared this approach with a method of calculating RAP using a 4-min moving window updated every 6 seconds (method 2). Results The study included 16 aSAH patients. We compared 43,653 4-min RAP observations of signals 1 and 2 (method 1), and 1,727,000 6-sec RAP observations (method 2). The two methods of calculating RAP produced similar results. Differences in RAP ≥0.4 in at least 7% of observations were seen in 5/16 (31%) patients. Moreover, the combination of a RAP of ≥0.6 in one signal and 0.2 was significantly associated with the frequency of BPEs (5 mmHg ≤ BPE <10 mmHg). Conclusions Simultaneous monitoring from two separate, close-by ICP sensors reveals significant differences in RAP that correspond to the occurrence of BPEs. As differences in RAP are of magnitudes that may alter patient management, we do not advocate the use of RAP in the management of

  18. Brain hypoxanthine concentration correlates to lactate/pyruvate ratio but not intracranial pressure in patients with acute liver failure

    DEFF Research Database (Denmark)

    Bjerring, Peter Nissen; Hauerberg, John; Jørgensen, Linda

    2010-01-01

    The pathogenesis of cerebral edema in acute liver failure is suggested, in in vitro and animal studies, to involve a compromised oxidative metabolism with a decrease in cerebral ATP levels and an increase in purine concentrations. In this study we hypothesize that the cerebral concentrations...... of hypoxanthine, inosine, and lactate/pyruvate (LP) ratio are increased and correlated in patients with acute liver failure. Furthermore, we expect the purines and L/P ratio to correlate with intracranial pressure (ICP) (positively), and cerebral perfusion pressure (CPP) (negatively)....

  19. 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

  20. 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.

  1. 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

  2. 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)

  3. Noninvasive intracranial pressure monitoring via optic nerve sheath diameter for robotic surgery in steep Trendelenburg position

    Directory of Open Access Journals (Sweden)

    Shagun Bhatia Shah

    2015-01-01

    Full Text Available Background: Recent reports of increased intracranial pressure (ICP due to steep Trendelenburg (ST position causing neurological deterioration, decreased regional cerebral oxygen saturation and postoperative visual loss after robotic urological and gynecological surgeries led us to consider a simple technique of ICP monitoring. Ours is one of the first instances reported of quantitative noninvasive measurement of increase in ICP with ST position by serial measurement of binocular optic nerve sheath diameter (ONSD in patients undergoing robot assisted urological and gynecological oncosurgery. We tested whether ONSD values rose to above the upper limits of normal and for what length of time they remained elevated. Materials and Methods: Prospective, randomized, interventional, parallel group, active control study conducted on 252 American Society of Anesthesiologists I and II patients. ONSD was measured using 7.5 MHz linear ultrasound probe in supine and Trendelenburg positions. Statistics: Student′s t-test to compare the inter-group mean ONSD and the repetitive t-test for intra-group analysis. Result: Comparison of the mean ONSD values of both groups yielded a 2-tailed significance P <0.01 at all compared time points intra- and post-operatively. In Group-O (open surgery; supine position, the baseline mean bilateral ONSD was 4.36 mm, which did not show any statistically significant change throughout open surgery and postoperative period. On de-docking the robot, 6.2 mm was the mean ONSD value in Group-R (robotic group while 4.3 mm was the corresponding value in control Group-O. Conclusion: ONSD evaluation is a simple, quick, safe, readily available, reliable, cost effective, noninvasive, potential standard of care for screening and monitoring of patients undergoing robotic surgery in ST position.

  4. Diagnostic Accuracy of Optic Nerve Ultrasonography and Ophthalmoscopy in Prediction of Elevated Intracranial Pressure

    Directory of Open Access Journals (Sweden)

    Keihan Golshani

    2015-05-01

    Full Text Available Introduction: Elevated intracranial pressure (ICP is a major and potentially lethal disorder in patients admitted to the emergency department (ED. Several methods are being used to investigate for elevated ICP. Here we assessed and compared the diagnostic accuracy of two existing tools of ophthalmoscopy and optic nerve ultrasonography in detection of elevated ICP. Methods: 131 participants with probable elevation of ICP referred to the emergency department of Al-Zahra Hospital, Isfahan, Iran, from 2012 to 2014, were enrolled. Brain computed tomography (CT scan, ultrasonography of optic nerve sheath, and ophthalmoscopy were performed for them. The optic nerves sheath with diameter more than 5 millimeters was considered as elevated ICP. Widening of optic nerve, ocular venous engorgement, blurring, hemorrhage over optic disk, elevation of optic disk, and retinal venous tortuosity were recorded as evidences of ICP rising in ophthalmoscopy. Diagnostic accuracy of the two tools in prediction of ICP rising were compared with the results of brain CT scan as a gold standard. Results: The mean age of participants was 46.29 ± 10 years (77% male. The number of diagnosed elevated ICPs with ophthalmoscopy and ultrasound were 98 (74.8% and 102 (77.9% cases, respectively. The calculated sensitivity and specificity of ophthalmoscopy and ultrasonography in detection of ICP rising were 100.0% (95% CI: 88.6-100.0 and 35.4% (95% CI: 26.0-46.2, 100.0% (95% CI: 84.0-100.0 and 31.9% (95% CI: 23.0-41.7, respectively. Conclusion: The present study reveals that bedside ultrasonography of optic nerve sheath and ophthalmoscopy have enough accuracy for screening of patients with probable elevation of ICP. Of course, it should be considered that despite of high sensitivity of both tools, their specificity is low.

  5. 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)

  6. Mortality and Outcome Comparison Between Brain Tissue Oxygen Combined with Intracranial Pressure/Cerebral Perfusion Pressure-Guided Therapy and Intracranial Pressure/Cerebral Perfusion Pressure-Guided Therapy in Traumatic Brain Injury: A Meta-Analysis.

    Science.gov (United States)

    Xie, Qiang; Wu, Hai-Bing; Yan, Yu-Feng; Liu, Meng; Wang, Er-Song

    2017-04-01

    The combination of brain tissue oxygen and standard intracranial pressure (ICP)/cerebral perfusion pressure (CPP)-guided therapy is thought to improve traumatic brain injury (TBI) prognosis compared with standard ICP/CPP-guided therapy. However, related results of previous observational studies and recently published cohort studies and randomized controlled trials (RCTs) remain controversial. The objective of this study was to compare the effect of the combined therapy with that of standard ICP/CPP-guided therapy on mortality rate, favorable outcome, ICP/CPP, and length of stay (LOS). We systematically searched PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and Web of Science in July 2016 for studies comparing the combined therapy and standard ICP/CPP-guided therapy. Random-effect and fixed-effect models were used for pooled analyses. After screening 362 studies, 8 cohort studies and 1 RCT were included. Primary outcomes were mortality and favorable outcome. The overall mortality risk ratio showed no obvious advantages between the 2 groups (risk ratio [RR], 0.76; 95% confidence interval [CI], 0.54-1.06) and discharge mortality (RR, 1.01; 95% CI, 0.80-1.26) and 3-month mortality (RR, 0.77; 95% CI, 0.53-1.12). Compared with the ICP/CPP group, the combined group was more likely to achieve better outcome during the 6 months after TBI (RR, 1.26; 95% CI, 1.04-1.52) or exactly at 6 months (RR, 1.34; 95% CI, 1.07-1.68), whereas ICP (standardized mean difference [SMD], -0.19; 95% CI, -0.43 to 0.05), CPP (SMD, 0.13; 95% CI, -0.09 to 0.35), and LOS (SMD, 0.13; 95% CI, -0.11 to 0.37) showed no obvious differences. Compared with standard ICP/CPP-guided therapy, brain tissue oxygen combined with ICP/CPP-guided therapy improved long-term outcomes without any effects on mortality, ICP/CPP, or LOS. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Analyses of cerebral microdialysis in patients with traumatic brain injury: relations to intracranial pressure, cerebral perfusion pressure and catheter placement

    Directory of Open Access Journals (Sweden)

    Wanecek Michael

    2011-03-01

    Full Text Available Abstract Background Cerebral microdialysis (MD is used to monitor local brain chemistry of patients with traumatic brain injury (TBI. Despite an extensive literature on cerebral MD in the clinical setting, it remains unclear how individual levels of real-time MD data are to be interpreted. Intracranial pressure (ICP and cerebral perfusion pressure (CPP are important continuous brain monitors in neurointensive care. They are used as surrogate monitors of cerebral blood flow and have an established relation to outcome. The purpose of this study was to investigate the relations between MD parameters and ICP and/or CPP in patients with TBI. Methods Cerebral MD, ICP and CPP were monitored in 90 patients with TBI. Data were extensively analyzed, using over 7,350 samples of complete (hourly MD data sets (glucose, lactate, pyruvate and glycerol to seek representations of ICP, CPP and MD that were best correlated. MD catheter positions were located on computed tomography scans as pericontusional or nonpericontusional. MD markers were analyzed for correlations to ICP and CPP using time series regression analysis, mixed effects models and nonlinear (artificial neural networks computer-based pattern recognition methods. Results Despite much data indicating highly perturbed metabolism, MD shows weak correlations to ICP and CPP. In contrast, the autocorrelation of MD is high for all markers, even at up to 30 future hours. Consequently, subject identity alone explains 52% to 75% of MD marker variance. This indicates that the dominant metabolic processes monitored with MD are long-term, spanning days or longer. In comparison, short-term (differenced or Δ changes of MD vs. CPP are significantly correlated in pericontusional locations, but with less than 1% explained variance. Moreover, CPP and ICP were significantly related to outcome based on Glasgow Outcome Scale scores, while no significant relations were found between outcome and MD. Conclusions The

  8. 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.

  9. Disseminated Cryptococcosis With Severe Increased Intracranial Pressure Complicated With Cranial Nerve Palsy in a Child.

    Science.gov (United States)

    Aldemir Kocabaş, Bilge; Emin Parlak, Mehmet; Özhak Baysan, Betil; Karaali, Kamil; Bingöl, Ayşen; Haspolat, Şenay

    2018-04-01

    Cryptococcosis is less common in children than in adults but remains an important cause of pneumonia and meningoencephalitis in both immunocompromised and immunocompetent patients. Intracranial hypertension commonly complicates cryptococcal meningitis and may cause significant visual and neurologic morbidity and mortality. Early and aggressive management of intracranial hypertension in accordance with established guidelines reduces the risk of long-term complications and death. In this case report, we present a 12-year-old girl with cryptococcal meningitis, pneumonitis and dermatitis complicated with cranial nerve palsy and loss of vision. She was successfully treated with serial cerebrospinal fluid drainage, antifungal and interferon gamma therapy.

  10. 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

  11. Contralateral extradural hematoma following decompressive craniectomy for acute subdural hematoma (the value of intracranial pressure monitoring): a case report.

    Science.gov (United States)

    Meguins, Lucas Crociati; Sampaio, Gustavo Botelho; Abib, Eduardo Cintra; Adry, Rodrigo Antônio Rocha da Cruz; Ellakkis, Richam Faissal El Hossain; Ribeiro, Filipe Webb Josephson; Maset, Ângelo Luiz; de Morais, Dionei Freitas

    2014-05-16

    Decompressive surgery for acute subdural hematoma leading to contralateral extradural hematoma is an uncommon event with only few cases previously reported in the English medical literature. The present study describes the case of a 39-year-old White Brazilian man who had a motorcycle accident; he underwent decompressive craniectomy for the treatment of acute subdural hematoma and evolved contralateral extradural hematoma following surgery. The present case highlights the importance of close monitoring of the intracranial pressure of severe traumatic brain injury, even after decompressive procedures, because of the possible development of contralateral extradural hematoma.

  12. 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

  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

    (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...

  14. 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

  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. 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 effects in all parameters were more pronounced for SAH than for saline injection. CONCLUSIONS: This study revealed that both the elevation of intracranial pressure and subarachnoid blood per se contribute approximately equally to the late CBF reductions and receptor upregulation following SAH....

  17. 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.

  18. [Cerebrovascular fiberoptic catheter oximetry in an intracranial pressure model in swine. New aspects of a clinical routine].

    Science.gov (United States)

    Menzel, M; Rieger, A; Roth, S; Sanchin, L; Soukup, J; Hennig, C; Furka, H; Burkert, W; Radke, J

    1997-02-01

    The reliability of continuous fibreoptic oximetry in cerebral venous blood and its correlation with intracranial and cerebral perfusion pressures (pressure-volume curve) were examined in an experimental porcine study. The pressure in the infratentorial compartment of 13 domestic pigs (18-24 kg) was gradually increased by inflating a Fogarty balloon catheter placed on the surface of the right cerebellar hemisphere and below the tentorium. Single volumes of 0.4 ml saline were injected into the inflatable balloon at 1-min intervals up to a total volume of 7 ml. Intracranial pressure (ICP), arterial blood pressure, cerebral perfusion pressure (CPP), and cerebral venous saturation measured continuously by fibreoptic oximetry and intermittent blood-gas analyses (SjO2 superior sagittal sinus) were monitored during balloon inflation. All data were down-loaded onto a PC and evaluated off-line by a commercial statistical software package. Over the whole pressure-volume curve, two phases of SjO2 behaviour were registered by continuous fibreoptic oximetry (Oximetrix 3, Abbott) (Fig. 1). CPP ranges of less than 50% reduction from the initial value showed a linear correlation (rmittl. = 0.712, P < 0.01) between both parameters (CPP-SjO2). In CPP ranges below a crucial point of about 50 mmHg no such correlation was found (rmittl = 0.176, P < 0.5). In contrast, in 3 pigs a very good correlation was found between CPP and SjO2 over the whole pressure-volume curve as measured by blood-gas analyses of samples from the cerebrovenous catheter (rmittl. = 0.84, P < 0.05). We conclude that in physiological CPP ranges down to 50 mmHg, SjO2 measurement is a reliable method of detecting oxygen desaturation in cerebrovenous blood. Below that CPP value, the fibreoptic catheter showed repeated false-high oxygen saturation values. The accuracy of SjO2 measurement seems to depend on sufficient cerebral blood flow (CBF): with decreasing CBF the amount of cerebral venous outflow is diminished. We

  19. 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.

  20. 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.

  1. 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.

  2. 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

  3. 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...

  4. Changes in intracranial pressure gradients between the cerebral hemispheres in patients with intracerebral hematomas in one cerebral hemisphere.

    Science.gov (United States)

    Qiu, Wusi; Jiang, Qizhou; Xiao, Guoming; Wang, Weiming; Shen, Hong

    2014-01-01

    Intracranial-pressure (ICP) monitoring is useful for patients with increased ICP following hemorrhagic stroke. In this study, the changes in pressure gradients between the two cerebral hemispheres were investigated after hemorrhagic stroke of one side, and after a craniotomy. Twenty-four patients with acute cerebral hemorrhages and intracerebral hematomas who exhibited mass effect and midline shift to the contralateral side on computed tomography were selected for this study. After admission, both sides of the cranium were drilled, and optical fiber sensors were implanted to monitor the brain parenchyma pressure (BPP) in both cerebral hemispheres. All patients underwent surgical hematoma evacuations. The preoperative and postoperative BPP data from both cerebral hemispheres were collected at various time points and compared pairwise. There were statistically significant differences (P 0.05). The posteroperative BPPs of both hemispheres were statistically significantly lower than preoperative recordings. BPP sensors should be applied to the injured cerebral hemisphere, because this becomes the source of increased ICP. Hematoma evacuation surgery effectively decreases ICP and eliminates pressure gradients between the two cerebral hemispheres, consequently enabling brain shift correction.

  5. [Idiopathic intracranial hypertension: a caesarean with epidural anaesthesia after bringing the cerebrospinal fluid pressure back to normal].

    Science.gov (United States)

    Pérez Rodríguez, M; de Carlos Errea, J; Dorronsoro Auzmendi, M; Batllori Gastón, M

    2013-12-01

    Idiopathic intracranial hypertension is diagnosed by exclusion. Because of its uncertain physiopathology and infrequent occurrence, its anaesthetic management is not well defined. The patient in this case is a pregnant woman with this disease with no lumbar-peritoneal shunt who was referred for non-urgent caesarean section, consisting of CSF drainage and pressure normalisation before the administration of epidural anaesthesia. We believe this technique can de effective to achieve adequate blockage and increased patient comfort, as well as improving postoperative recovery. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  6. Optic nerve sheath diameter, intracranial pressure and acute mountain sickness on Mount Everest: a longitudinal cohort study.

    Science.gov (United States)

    Sutherland, A I; Morris, D S; Owen, C G; Bron, A J; Roach, R C

    2008-03-01

    To investigate the association of optic nerve sheath diameter (ONSD), as a correlate of intracranial pressure (ICP), with acute mountain sickness (AMS). Longitudinal cohort study of mountaineers from sea level to 6400 m. Mount Everest (North side). 13 mountaineers (10 men, 3 women; aged 23-52 years) on a British expedition to climb Mount Everest. ONSD was measured ultrasonically, 3 mm behind the globe using B scans recorded with an OTI-Scan 3D scanner (Ophthalmic Technologies, Canada). Serial binocular scans were recorded at sea level, and 2000, 3700, 5200 and 6400 m. All ONSDs were measured by a blinded observer. ONSD, AMS score (using the Lake Louise scoring system), heart rate, and oxygen saturation levels. All results were analysed by regression analysis with adjustment. ONSD was positively associated with increasing altitude above sea level (0.10 mm increase in ONSD per 1000 m, 95% CI 0.05 to 0.14 mm) and AMS score (0.12 mm per score, 95% CI 0.06 to 0.18 mm); further associations were found with resting heart rate (0.29 mm per 20 beats/min, 95% CI 0.17 to 0.41 mm) and oxygen saturations (0.20 mm per 10% decrease, 95% CI 0.11 to 0.29 mm). ONSD increases at high altitude, and this increase is associated with more severe symptoms of AMS. Given the linkage between ONSD and ICP, these results strongly suggest that intracranial pressure plays an important role in the pathophysiology of AMS.

  7. Can intracranial pressure be measured non-invasively bedside using a two-depth Doppler-technique?

    Science.gov (United States)

    Koskinen, Lars-Owe D; Malm, Jan; Zakelis, Rolandas; Bartusis, Laimonas; Ragauskas, Arminas; Eklund, Anders

    2017-04-01

    Measurement of intracranial pressure (ICP) is necessary in many neurological and neurosurgical diseases. To avoid lumbar puncture or intracranial ICP probes, non-invasive ICP techniques are becoming popular. A recently developed technology uses two-depth Doppler to compare arterial pulsations in the intra- and extra-cranial segments of the ophthalmic artery for non-invasive estimation of ICP. The aim of this study was to investigate how well non-invasively-measured ICP and invasively-measured cerebrospinal fluid (CSF) pressure correlate. We performed multiple measurements over a wide ICP span in eighteen elderly patients with communicating hydrocephalus. As a reference, an automatic CSF infusion apparatus was connected to the lumbar space. Ringer's solution was used to create elevation to pre-defined ICP levels. Bench tests of the infusion apparatus showed a random error (95 % CI) of less than ±0.9 mmHg and a systematic error of less than ±0.5 mmHg. Reliable Doppler signals were obtained in 13 (72 %) patients. An infusion test could not be performed in one patient. Thus, twelve patients and a total of 61 paired data points were studied. The correlation between invasive and non-invasive ICP measurements was good (R = 0.74), and the 95 % limits of agreements were -1.4 ± 8.8 mmHg. The within-patient correlation varied between 0.47 and 1.00. This non-invasive technique is promising, and these results encourage further development and evaluation before the method can be recommended for use in clinical practice.

  8. Brief Report: Flow Rate of Cerebrospinal Fluid Through a Spinal Needle Can Accurately Predict Intracranial Pressure in Cryptococcal Meningitis.

    Science.gov (United States)

    Boyles, Tom H; Gatley, Elizabeth; Wasserman, Sean; Meintjes, Graeme

    2017-03-01

    Patients with HIV-associated cryptococcal meningitis (CM) commonly present with raised intracranial pressure (ICP). Aggressive management of raised ICP reduces mortality but requires manometers, which are unavailable in most resource-limited settings. The law of Poiseuille states that the rate of flow of liquid through a tube is directly proportional to the difference in pressure between each end, and it may be possible to indirectly determine ICP by measuring flow of CSF through a spinal needle rather than using a manometer. A convenience sample of CM patients requiring lumbar puncture (LP) (with 22-G spinal needle) for ICP measurement and control were enrolled. ICP was first measured using a narrow bore manometer. After removing the manometer, the number of drops of CSF flowing from the spinal needle in 15 seconds was counted. Thirty-two patients had 89 LPs performed (range, 1-23). Fifty-four had high opening pressure with a CSF flow rate of 16-200 drops/min, and 35 had normal pressure with a CSF flow rate of 8-140 drops/min. Area under the fitted receiver operator character curve was 0.89. A flow rate cutoff to define high pressure of ≥40 drops/min correctly classified 75 of 89 LPs (accuracy 84%). It is technically feasible to indirectly estimate CSF pressure to an accuracy that is clinically useful by counting drops of CSF flowing from a spinal needle. The optimal cutoff value for defining high pressure using a standard 22-G spinal needle is ≥40 drops/min. These findings have the potential to improve CM management in resource-limited settings.

  9. 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.

  10. Ventriculoperitoneal shunts for treating increased intracranial pressure in cryptococcal meningitis with or without ventriculomegaly

    Directory of Open Access Journals (Sweden)

    Marcelo Corti

    2014-07-01

    Full Text Available Introduction Cryptococcosis is an opportunistic mycosis, especially in patients that are human immunodeficiency virus (HIV-positive, and frequently involves the central nervous system. Methods We assessed the potential of ventriculoperitoneal shunting (VPS in preventing mortality due to uncontrollable intracranial hypertension (ICH in 15 patients with acquired immunodeficiency syndrome (AIDS-related cryptococcal meningitis. Results After 2 weeks of antifungal therapy consisting of amphotericin B deoxycholate with or without fluconazole, patients with persistent ICH underwent VPS, despite having persistent Cryptococcus neoformans infection. In 12 patients, the uncontrollable ICH was resolved by VPS. Conclusions Patients with cryptococcal meningoencephalitis who have ICH must be considered for VPS even with positive cerebrospinal fluid cultures.

  11. Noninvasive assessment of intracranial pressure in dogs by use of biomechanical response behavior, diagnostic imaging, and finite element analysis.

    Science.gov (United States)

    Madison, Adrienne M; Sharma, Ajay; Haidekker, Mark A

    2015-08-01

    OBJECTIVE :To develop a novel method for use of diagnostic imaging, finite element analysis (FEA), and simulated biomechanical response behavior of brain tissue in noninvasive assessment and estimation of intracranial pressure (ICP) of dogs. MRI data for 5 dogs. MRI data for 5 dogs (1 with a geometrically normal brain that had no detectable signs of injury or disease and 4 with various degrees of geometric abnormalities) were obtained from a digital imaging archiving and communication system database. Patient-specific 3-D models composed of exact brain geometries were constructed from MRI images. Finite element analysis was used to simulate and observe patterns of nonlinear biphasic biomechanical response behavior of geometrically normal and abnormal canine brains at various levels of decreasing cerebral perfusion pressure and increasing ICP. Changes in biomechanical response behavior were detected with FEA for decreasing cerebral perfusion pressure and increasing ICP. Abnormalities in brain geometry led to observable changes in deformation and biomechanical response behavior for increased ICP, compared with results for geometrically normal brains. In this study, patient-specific critical ICP was identified, which could be useful as a method to predict the onset of brain herniation. Results indicated that it was feasible to apply FEA to brain geometry obtained from MRI data of clinical patients and to use biomechanical response behavior resulting from increased ICP as a diagnostic and prognostic method to noninvasively assess or classify levels of brain injury in clinical veterinary settings.

  12. Lack of consistent intracranial pressure pulse morphological changes during episodes of microdialysis lactate/pyruvate ratio increase

    International Nuclear Information System (INIS)

    Asgari, Shadnaz; Vespa, Paul; Bergsneider, Marvin; Hu, Xiao

    2011-01-01

    Lactate/pyruvate ratio (LPR) from microdialysis is a well-established marker of cerebral metabolic crisis. For brain injury patients, abnormally high LPR could indicate cerebral ischemia or failure of O 2 uptake. However, there is a debate on the primary factor responsible for LPR increase. Exploiting the potential of using the morphology of a high temporal resolution signal such as intracranial pulse (ICP) to characterize cerebrovascular changes, a data analysis experiment is taken to test whether consistent changes in ICP pulse morphological metrics accompany the LPR increase. We studied 3517 h of LPR and continuous ICP data from 19 severe traumatic brain injury patients. Our morphological clustering and analysis of intracranial pressure (MOCAIP) algorithm was applied to ICP pulses, which were matched in time to the LPR measurements, and 128 pulse morphological metrics were extracted. We automatically identified the episodes of LPR increases using a moving time window of 10–20 h. We then studied the trending patterns of each of the 128 ICP MOCAIP metrics within these identified periods and determined them to be one of the following three types: increasing, decreasing or no trend. A binomial test was employed to investigate whether any MOCAIP metrics show a consistent trend among all episodes of LPR increase per patient. Regardless of the selected values for different parameters of the proposed method, for the majority of the subjects in the study (78%), none of the ICP metrics show any consistent trend during the episodes of LPR increase. Even for the few subjects who have at least one ICP metric with a consistent trend during the LPR increase episodes, the number of such metrics is small and varies from subject to subject. Given the fact that ICP pulse morphology is influenced by the cerebral vasculature, our results suggest that a dominant cerebral vascular cause may be behind the changes in LPR when LPR trends correlate with ICP pulse morphological changes

  13. In vitro experiment for verification of the tandem shunt valve system: a novel method for treating hydrocephalus by flexibly controlling cerebrospinal fluid flow and intracranial pressure.

    Science.gov (United States)

    Aihara, Yasuo; Shoji, Ichiro; Okada, Yoshikazu

    2013-01-01

    The CSF shunt valve is a medical device whose main function is to regulate intracranial pressure and drain excess CSF. The authors have developed a new therapeutic method for treating hydrocephalus, namely the tandem shunt valve system, which has the potential of flexibly controlling the CSF flow rate and intracranial pressure in patients. The properties of the tandem system were verified by performing in vitro experiments. An in vitro system with a manometer was built to measure pressure and flow rates of water in open systems using the Codman Hakim Programmable Valve and the Strata adjustable pressure programmable valve. A single valve and 2 single shunt valves connected in series (the tandem shunt valve system) were connected to the manometer to check the final pressure. Conventional single shunt valve systems require valve pressures to be set higher to slow down the CSF flow rate, which inevitably results in a higher final pressure. On the other hand, the tandem shunt valve system uses the combination of 2 valves to slow the CSF flow rate without increasing the final pressure. The authors succeeded in experimentally demonstrating in vitro results of tandem systems and their effectiveness by applying a model to show that the valve with the higher pressure setting determined the final pressure of the entire system and the flow rate became slower than single shunt valve systems.

  14. Can Transcranial Color Doppler Spectral Signatures be a Novel Biomarker for Monitoring Cerebrovascular Autoregulation and Intracranial Pressure? A Speculative Synthesis.

    Science.gov (United States)

    Mangalore, Sandhya; Kotresh; Srinivasa, Rakshith; Hegde, Alangar Sathyaranjandas; Srinivasa, Rangashetty

    2017-01-01

    Trans Cranial Colour Doppler (TCCD) has been extensively used in various neurological and neurosurgical conditions causing severe raise in the intracranial pressure (ICP). Our study explores the sequential evolution of TCCD flow pattern by correlating with pupillary reactivity, Glasgow coma scale (GCS), and imaging. Our cohort consisted of thirty patients with ten patients in each subgroup admitted to the neuro-Intensive Care Unit (NICU) for various neurological and neurosurgical causes. Middle cerebral artery was insonated through the transtemporal window at the time of admission to NICU. Doppler waveform and parameters such as peak systolic velocity, end-diastolic velocity, systolic by diastolic ratio, pulsatility index, and resistivity index were recorded. The clinical variables for evaluating the degree of raised ICP were the GCS and pupil size. Other systemic parameters such as mean arterial pressure, heart rate, and respiratory rate were also considered and these results were further correlated with TCCD findings. The groups were divided into three groups based on GCS, pupillary reactivity, and imaging. Imaging was done to indicate the etiology for ICP changes and also to look for signs of raised ICP. Ten distinct types of waveform patterns were noted, and these waveforms correlated with various physiological parameters suggestive of raised ICP. The sequential evolution of distinct patterns of Doppler waveform with increasing degree of raise in ICP has been described and can act as a quick screening tool in NICU and helps stratify patients for treatment and prognostication.

  15. Continuous Monitoring of Cerebrovascular Reactivity Using Pulse Waveform of Intracranial Pressure

    NARCIS (Netherlands)

    Aries, M.J.H.; Czosnyka, Marek; Budohoski, Karol P.; Kolias, Angelos G.; Radolovich, Danila K.; Lavinio, Andrea; Pickard, John D.; Smielewski, Peter

    Guidelines for the management of traumatic brain injury (TBI) call for the development of accurate methods for assessment of the relationship between cerebral perfusion pressure (CPP) and cerebral autoregulation and to determine the influence of quantitative indices of pressure autoregulation on

  16. 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

  17. 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.

  18. Early Detection of Increased Intracranial Pressure Episodes in Traumatic Brain Injury: External Validation in an Adult and in a Pediatric Cohort.

    Science.gov (United States)

    Güiza, Fabian; Depreitere, Bart; Piper, Ian; Citerio, Giuseppe; Jorens, Philippe G; Maas, Andrew; Schuhmann, Martin U; Lo, Tsz-Yan Milly; Donald, Rob; Jones, Patricia; Maier, Gottlieb; Van den Berghe, Greet; Meyfroidt, Geert

    2017-03-01

    A model for early detection of episodes of increased intracranial pressure in traumatic brain injury patients has been previously developed and validated based on retrospective adult patient data from the multicenter Brain-IT database. The purpose of the present study is to validate this early detection model in different cohorts of recently treated adult and pediatric traumatic brain injury patients. Prognostic modeling. Noninterventional, observational, retrospective study. The adult validation cohort comprised recent traumatic brain injury patients from San Gerardo Hospital in Monza (n = 50), Leuven University Hospital (n = 26), Antwerp University Hospital (n = 19), Tübingen University Hospital (n = 18), and Southern General Hospital in Glasgow (n = 8). The pediatric validation cohort comprised patients from neurosurgical and intensive care centers in Edinburgh and Newcastle (n = 79). None. The model's performance was evaluated with respect to discrimination, calibration, overall performance, and clinical usefulness. In the recent adult validation cohort, the model retained excellent performance as in the original study. In the pediatric validation cohort, the model retained good discrimination and a positive net benefit, albeit with a performance drop in the remaining criteria. The obtained external validation results confirm the robustness of the model to predict future increased intracranial pressure events 30 minutes in advance, in adult and pediatric traumatic brain injury patients. These results are a large step toward an early warning system for increased intracranial pressure that can be generally applied. Furthermore, the sparseness of this model that uses only two routinely monitored signals as inputs (intracranial pressure and mean arterial blood pressure) is an additional asset.

  19. Role of Intracranial Pressure Monitoring in Management of Patients with Severe Traumatic Brain Injury: Results of a Large Level I Trauma Center in Southern Iran.

    Science.gov (United States)

    Khalili, Hosseinali; Sadraei, Nazanin; Niakan, Amin; Ghaffarpasand, Fariborz; Sadraei, Amin

    2016-10-01

    To determine the role of intracranial pressure (ICP) monitoring in management of patients with severe traumatic brain injury (TBI) admitted to a large level I trauma center in Southern Iran. This was a cohort study performed during a 2-year period in a level I trauma center in Southern Iran including all adult patients (>16 years) with severe TBI (Glasgow Coma Scale [GCS] score, 3-8) who underwent ICP monitoring through ventriculostomy. The management was based on the recorded ICP values with threshold of 20 mm Hg. Decompressive craniectomy was performed in patients with intractable intracranial hypertension (persistent ICP ≥25 mm Hg). In unresponsive patients, barbiturate coma was induced. Patients were followed for 6 months and Glasgow Outcome Scale Extended was recorded. The determinants of favorable and unfavorable outcome were also determined. Overall, we included 248 patients with mean age of 34.6 ± 16.6 years, among whom there were 216 men (87.1%) and 32 women (12.9%). Eighty-five patients (34.2%) had favorable and 163 (65.8%) unfavorable outcomes. Those with favorable outcome had significantly lower age (P = 0.004), higher GCS score on admission (P intracranial hypertension (P intracranial hypertension, and maximum recorded ICP are important determinants of outcome in patients with severe TBI. ICP monitoring assisted us in targeted therapy and management of patients with severe TBI. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Identification of an Intracranial Pressure (ICP) Response Function from Continuously Acquired Electroencephalographic and ICP Signals in Burst-Suppressed Patients.

    Science.gov (United States)

    Connolly, Mark; Liou, Raymond; Vespa, Paul; Hu, Xiao

    2016-01-01

    Continuous intracranial pressure (ICP) and electroencephalographic (EEG) monitoring are used in the management of patients with brain injury. It is possible that these two signals could be related through neurovascular coupling. To explore this mechanism, we modeled the ICP response to brain activity by treating spontaneous burst activity in burst-suppressed patients as an impulse, and identified the ICP response function (ICPRF) as the subsequent change in ICP.Segments of ICP were filtered, classified as elevating or stable, and suitable ICPRFs were identified. After calibration, each ICPRF was convolved with the EEG to produce the estimated ICP. The mean error (ME) versus distance from the selected ICPRF was calculated and the elevating and stable ICP segments compared.Eighty-four ICPRFs were identified from 15 data segments. The ME of the elevating segments increased at an average rate of 57 mmHg/min, whereas the average ME of the stable segments increased at a rate of 0.05 mmHg/min.These findings demonstrate that deriving an ICPRF from a burst-suppressed patient is a suitable approach for stable segments. To completely model the ICP response to EEG activity, a more robust model should be developed.

  1. National Variability in Intracranial Pressure Monitoring and Craniotomy for Children With Moderate to Severe Traumatic Brain Injury

    Science.gov (United States)

    Van Cleve, William; Kernic, Mary A.; Ellenbogen, Richard G.; Wang, Jin; Zatzick, Douglas F.; Bell, Michael J.; Wainwright, Mark S.; Groner, Jonathan I.; Mink, Richard B.; Giza, Christopher C.; Boyle, Linda Ng; Mitchell, Pamela H.; Rivara, Frederick P.; Vavilala, Monica S.

    2014-01-01

    BACKGROUND Traumatic brain injury (TBI) is a significant cause of mortality and disability in children. Intracranial pressure monitoring (ICPM) and craniotomy/craniectomy (CRANI) may affect outcomes. Sources of variability in the use of these interventions remain incompletely understood. OBJECTIVE To analyze sources of variability in the use of ICPM and CRANI. METHODS Retrospective cross-sectional study of patients with moderate/severe pediatric TBI with the use of data submitted to the American College of Surgeons National Trauma Databank. RESULTS We analyzed data from 7140 children at 156 US hospitals during 7 continuous years. Of the children, 27.4% had ICPM, whereas 11.7% had a CRANI. Infants had lower rates of ICPM and CRANI than older children. A lower rate of ICPM was observed among children hospitalized at combined pediatric/adult trauma centers than among children treated at adult-only trauma centers (relative risk = 0.80; 95% confidence interval 0.66-0.97). For ICPM and CRANI, 18.5% and 11.6%, respectively, of residual model variance was explained by between-hospital variation in care delivery, but almost no correlation was observed between within-hospital tendency toward performing these procedures. CONCLUSION Infants received less ICPM than older children, and children hospitalized at pediatric trauma centers received less ICPM than children at adult-only trauma centers. In addition, significant between-hospital variability existed in the delivery of ICPM and CRANI to children with moderate-severe TBI. PMID:23863766

  2. Modifications of intracranial pressure after molecular adsorbent recirculating system treatment in patients with acute liver failure: case reports.

    Science.gov (United States)

    Pugliese, F; Ruberto, F; Perrella, S M; Cappannoli, A; Bruno, K; Martelli, S; Celli, P; Summonti, D; D'Alio, A; Tosi, A; Novelli, G; Morabito, V; Poli, L; Rossi, M; Berloco, P B; Pietropaoli, P

    2007-01-01

    Cerebral dysfunction may be fatal in patients with acute liver failure (ALF); intracranial pressure (ICP) monitoring may be mandatory to direct measures to prevent further cerebral edema. Recently the introduction of dialysis with the molecular adsorbent recirculating system (MARS) has improved the outcomes among patients with ALF. The aim of this study was to evaluate ICP changes after MARS treatment among patients with ALF. Three patients -- 14, 18 and 16 years old -- were admitted to the ICU for acute liver failure induced by HBV in two cases and by acetaminophen in the other one. Because of Glasgow Coma Score (GCS) MARS treatments were performed in all patients. The patients received MARS treatments every day after their admission to liver transplantation. After MARS therapy the ICP decreased on average from 21 to 7 mm Hg. Significant hemodynamic modifications were not observed and their neurological conditions improved. MARS treatment improved the clinical pictures of these patients increasing the available time to obtain an urgent liver graft.

  3. Analysis of intracranial pressure recordings: comparison of PCA and signal averaging based filtering methods and signal period estimation.

    Science.gov (United States)

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

    2010-01-01

    Intracranial pressure monitoring is a common used approach for neuro-intensive care in cases of brain damages and injuries or to investigate chronic pathologies. Several types of noises and artifacts normally contaminate ICP recordings. They can be sorted in 2 classes, i.e. high-frequency noises (due to measurement and amplifier devices or electricity supply presence) and low-frequency noises (due to unwanted patient's movement, speeches, coughing during the recording and quantization noise). Thus, deep investigations on ICP components aimed to extract features from ICP signal, require a denoised signal. For this reason the authors have addressed a study upon the most common filtering techniques. On each ICP recording we have performed 4 configurations of filters, which involve the use of a FIR filter together with Signal Averaging filters or PCA based filters. Next step is period estimation for absolute minima detection. The results obtained by the algorithm for automatic ICP marking are compared to those ones obtained from manual marking (peaks are manually identified and annotated by a brain surgeon). The procedure is repeated varying the filters sliding window size to minimize the mean square error. The results show how the configurations FIR filter + Signal averaging provides smaller mean squared error (MSE=118.84[sample(2)]) than the others 3 configurations FIR filter + PCA filter based (MSE=135.29-147.15[sample(2)]).

  4. “Spontaneous” CSF Fistula due to Transtegmental Brain Herniation in Combination with Signs of Increased Intracranial Pressure and Petrous Bone Hyperpneumatization: An Illustrative Case Report

    Science.gov (United States)

    Rivera, Diones; Fermin-Delgado, Rafael; Stoeter, Peter

    2014-01-01

    Background and Importance Transtegmental brain herniation into the petrous bone is a rare cause of rhinoliquorrhea. Our case presents a combination of several typical clinical and imaging findings illustrating the ongoing etiologic discussion of such cerebrospinal fluid (CSF) fistulas. Clinical Presentation A 53-year-old man presented with nasal discharge after a strong effort to suppress coughing. Imaging revealed a transtegmental herniation of parts of the inferior temporal gyrus into the petrous bone and in addition a combination of signs of chronically increased intracranial pressure and a hyperpneumatization of the petrous bone. The fistula was closed by a middle cranial fossa approach. Conclusion The case illustrates the two main predisposing factors for development of petrous bone CSF fistulas: increased intracranial pressure and thinning of the tegmental roof due to extensive development of air cells. Because the CSF leakage repair does not change the underlying cause, patients have to be informed about the possibility of developing increased intracranial pressure and recurrences of brain herniations at other sites. PMID:25485224

  5. The effect of decerebrate rigidity on the intracranial pressure: an experimental study.

    Science.gov (United States)

    Tsementzis, S A; Gillingham, F J; Hitchcock, E R; Gordon, A

    1979-01-01

    The mechanical effect of acute decerebrate rigidity upon the ICP and the mechanisms underlying the relationship between them have been investigated with experiments performed on 26 cats. It has been shown that: a) Extreme rigidity of the peripheral musculature with or without partial activation of the trunkal muscles produces no change in ICP, b) the simultaneous elevation of the intra-thoracic and intra-abdominal pressures is the factor primarily operative in raising and maintaining the elevated ICP, c) when cerebrovascular homeostasis is already defective a subsidiary but not unimportant role is played by the elevation of the systemic arterial pressure, d) under conditions of normal brain elastance mild and short-lasting spasms produce no effect on the ICP. In an animal, however, in which the brain elastance had been increased by inflating a small air-filled balloon, similar spasms produced a marked increase in ICP.

  6. 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

    "as normal as possible" i.e. without indication for neurosurgical intervention (e.g. focal lesions, global edema, abnormalities in ICP-profile or cerebrospinal fluid dynamics). ICP (tip-transducer probe, Raumedic) in the brain parenchyma (N=7) or in the lateral ventricles (N=2) and cardiovascular...... 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...... veins may protect the brain from being exposed to a large negative pressure when upright. Despite positional changes in ICP, MAP keeps CPP tightly regulated....

  7. 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

  8. A Method of Managing Severe Traumatic Brain Injury in the Absence of Intracranial Pressure Monitoring: The Imaging and Clinical Examination Protocol.

    Science.gov (United States)

    Chesnut, Randall M; Temkin, Nancy; Dikmen, Sureyya; Rondina, Carlos; Videtta, Walter; Petroni, Gustavo; Lujan, Silvia; Alanis, Victor; Falcao, Antonio; de la Fuenta, Gustavo; Gonzalez, Luis; Jibaja, Manuel; Lavarden, Arturo; Sandi, Freddy; Mérida, Roberto; Romero, Ricardo; Pridgeon, Jim; Barber, Jason; Machamer, Joan; Chaddock, Kelley

    2018-01-01

    The imaging and clinical examination (ICE) algorithm used in the Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure (BEST TRIP) randomized controlled trial is the only prospectively investigated clinical protocol for traumatic brain injury management without intracranial pressure (ICP) monitoring. As the default literature standard, it warrants careful evaluation. We present the ICE protocol in detail and analyze the demographics, outcome, treatment intensity, frequency of intervention usage, and related adverse events in the ICE-protocol cohort. The 167 ICE protocol patients were young (median 29 years) with a median Glasgow Coma Scale motor score of 4 but with anisocoria or abnormal pupillary reactivity in 40%. This protocol produced outcomes not significantly different from those randomized to the monitor-based protocol (favorable 6-month extended Glasgow Outcome Score in 39%; 41% mortality rate). Agents commonly employed to treat suspected intracranial hypertension included low-/moderate-dose hypertonic saline (72%) and mannitol (57%), mild hyperventilation (adjusted partial pressure of carbon dioxide 30-35 mm Hg in 73%), and pressors to maintain cerebral perfusion (62%). High-dose hyperosmotics or barbiturates were uncommonly used. Adverse event incidence was low and comparable to the BEST TRIP monitored group. Although this protocol should produce similar/acceptable results under circumstances comparable to those in the trial, influences such as longer pre-hospital times and non-specialist transport personnel, plus an intensive care unit model of aggressive physician-intensive care by small groups of neurotrauma-focused intensivists, which differs from most high-resource models, support caution in expecting the same results in dissimilar settings. Finally, this protocol's ICP-titration approach to suspected intracranial hypertension (vs. crisis management for monitored ICP) warrants further study.

  9. In-house development of a dedicated data acquisition and monitoring system for intracranial pressure, patient posture and patient symptoms in a regional neurosciences centre.

    Science.gov (United States)

    Marsden, S P; Boddy, I J S; Strachan, R D; Chambers, I R

    2016-02-01

    Management of traumatic brain injury and cerebrospinal fluid (CSF) flow disorders can be aided by measurement and monitoring of intracranial pressure (ICP). In addition to pressure measurement, knowledge of patient symptoms and posture during monitoring are also valuable, particularly in the management of CSF flow disorders. ICP monitoring systems have been developed in this centre to meet clinical needs in the absence of commercially available solutions. An early system (mark I) was developed and the technical challenges in its design are described, along with limitations to this system that motivated the development of a new mark II system. The mark II system is then described.

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

    Science.gov (United States)

    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

    2016-01-01

    Abstract 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  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 < 0.05; 95% CI = 9.17 mm Hg; 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. PMID:26414916

  11. 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.

  12. 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.

  13. Effect of Positive End-Expiratory Pressure on the Sonographic Optic Nerve Sheath Diameter as a Surrogate for Intracranial Pressure during Robot-Assisted Laparoscopic Prostatectomy: A Randomized Controlled Trial.

    Science.gov (United States)

    Chin, Ji-Hyun; Kim, Wook-Jong; Lee, Joonho; Han, Yun A; Lim, Jinwook; Hwang, Jai-Hyun; Cho, Seong-Sik; Kim, Young-Kug

    2017-01-01

    Positive end-expiratory pressure (PEEP) can increase intracranial pressure. Pneumoperitoneum and the Trendelenburg position are associated with an increased intracranial pressure. We investigated whether PEEP ventilation could additionally influence the sonographic optic nerve sheath diameter as a surrogate for intracranial pressure during pneumoperitoneum combined with the Trendelenburg position in patients undergoing robot-assisted laparoscopic prostatectomy. After anesthetic induction, 38 patients were randomly allocated to a low tidal volume ventilation (8 ml/kg) without PEEP group (zero end-expiratory pressure [ZEEP] group, n = 19) or low tidal volume ventilation with 8 cmH2O PEEP group (PEEP group, n = 19). The sonographic optic nerve sheath diameter was measured prior to skin incision, 5 min and 30 min after pneumoperitoneum and the Trendelenburg position, and at the end of surgery. The study endpoint was the difference in the sonographic optic nerve sheath diameter 5 min after pneumoperitoneum and the Trendelenburg position between the ZEEP and PEEP groups. Optic nerve sheath diameters 5 min after pneumoperitoneum and the Trendelenburg position did not significantly differ between the groups [least square mean (95% confidence interval); 4.8 (4.6-4.9) mm vs 4.8 (4.7-5.0) mm, P = 0.618]. Optic nerve sheath diameters 30 min after pneumoperitoneum and the Trendelenburg position also did not differ between the groups [least square mean (95% confidence interval); 4.5 (4.3-4.6) mm vs 4.5 (4.4-4.6) mm, P = 0.733]. An 8 cmH2O PEEP application under low tidal volume ventilation does not induce an increase in the optic nerve sheath diameter during pneumoperitoneum combined with the steep Trendelenburg position, suggesting that there might be no detrimental effects of PEEP on the intracranial pressure during robot-assisted laparoscopic prostatectomy. ClinicalTrial.gov NCT02516566.

  14. High Blood Pressure Increases the Risk of Poor Outcome at Discharge and 12-month Follow-up in Patients with Symptomatic Intracranial Large Artery Stenosis and Occlusions: Subgroup analysis of the CICAS Study.

    Science.gov (United States)

    Yu, Dan-Dan; Pu, Yue-Hua; Pan, Yue-Song; Zou, Xin-Ying; Soo, Yannie; Leung, Thomas; Liu, Li-Ping; Wang, David Z; Wong, Ka-Sing; Wang, Yi-Long; Wang, Yong-Jun

    2015-06-01

    The purpose of this study was to discuss the relationship between blood pressure and prognosis of patients with symptomatic intracranial arterial stenosis. Data on 2426 patients with symptomatic intracranial large artery stenosis and occlusion who participated in the Chinese Intracranial Atherosclerosis (CICAS) study were analyzed. According to the JNC 7 criteria, blood pressure of all patients was classified into one of the four subgroups: normal, prehypertension, hypertension stage I, and hypertension stage II. Poor outcomes were defined as death and functional dependency (mRS 3-5) at discharge or at 1 year. For patients with intracranial stenosis of 70% to 99%, the rate of poor outcome at discharge was 19.3%, 23.5%, 26.8%, and 39.8% (P = 0.001) for each blood pressure subgroup. For patients with intracranial large artery occlusion, the rates were 17.6%, 22.1%, 29.5%, and 49.8%, respectively (P pressure subgroup and 11.6%, 21.5%, 23.9%, 35.1% (P intracranial arterial stenosis or occlusion, higher hypertension stages are associated with an increased risk of poor outcome at discharge and 12-month follow-up. © 2015 The Authors. CNS Neuroscience & Therapeutics Published by John Wiley & Sons Ltd.

  15. Bedside burr hole for intracranial pressure monitoring performed by pediatric intensivists in children with CNS infections in a resource-limited setting: 10-year experience at a single center.

    Science.gov (United States)

    Singhi, Sunit; Kumar, Ramesh; Singhi, Pratibha; Jayashree, Muralidharan; Bansal, Arun

    2015-06-01

    Intracranial pressure monitoring can help in early identification of raised intracranial pressure and in setting more informed goals for treatment. We describe our 10-year experience of bedside burr holes performed by pediatric intensivists to establish intracranial pressure monitoring in children with CNS infections in a resource-limited setting and the technical difficulties and complications encountered. Descriptive study of prospectively recorded data. PICU of a tertiary care academic institute. Consecutive comatose patients with raised intracranial pressure who underwent intracranial pressure monitoring from 2004 to 2013. An intraparenchymal (1.2 mm) or an intraventricular transducer (3.4 mm) (Codman) was placed by a pediatric intensivist through a micro burr hole using a standard protocol. Technical difficulties during the procedure and complications were recorded. Over 10 years, 265 intracranial pressure catheters were placed in 259 patients, mainly for acute CNS infections (n = 242, 93.4%). Median age of patients was 4.8 years, youngest being 6 weeks; 21 patients (8.1%) were younger than 1 year. Intraparenchymal transducer was used in 252 patients (97.3%). Median (interquartile range) duration of intracranial pressure monitoring was 96 hours (72-144 hr). Complications were seen in 3.5% of patients (n = 9/259); the incidence was 0.28 per 1,000 hours of intracranial pressure monitoring. Procedure-related ventriculitis occurred in three of seven patients (42.8%) with intraventricular catheter, in contrast to none in patients with intraparenchymal transducer. Overall mortality was 32.8% (n = 85). On Cox-regression analysis, "blood component therapy" was an independent predictor of poor outcome defined as death or severe neurodisability (adjusted hazard ratio, 1.58; 95% CI, 1.16-2.16; p = 0.004). In a resource-limited setting, pediatric intensivists can safely and successfully perform burr holes at bedside for establishing intraparenchymal intracranial pressure

  16. Influence of the individual DPOAE growth behavior on DPOAE level variations caused by conductive hearing loss and elevated intracranial pressure.

    Science.gov (United States)

    Deppe, Christoph; Kummer, Peter; Gürkov, Robert; Olzowy, Bernhard

    2013-01-01

    Minor conductive hearing loss (CHL) can compromise the evaluation of the inner ear function with distortion product otoacoustic emissions (DPOAE). Elevation of the intracranial pressure (ICP) is also expected to alter the middle ear (ME) sound transmission. An impaired ME sound transmission leads to an attenuation of the DPOAE primary tone levels (L1 and L2) during forward transmission and of DPOAE levels (LDP) during backward transmission. The effect of the attenuation of L1 and L2 is complex and might have unexpected effects on DPOAE levels. In this work, CHL- and ICP-induced alterations of LDP versus L1 growth functions (constant L2 and increasing L1) are investigated. The first aim of this study is to explain how alterations of ME sound transmission can affect DPOAEs and to characterize the dependency of DPOAE level alterations on L2,L1 combinations and on the individual shape of LDP versus L1 growth functions. The second aim is to identify analogies between CHL- and ICP-induced alterations of DPOAEs and to discuss implications for a potential noninvasive ICP monitoring. This study focuses on general theoretical considerations, supported by selected experimental observations in different species and simulations. DPOAEs were measured in guinea pigs before and after induction of a CHL (1 ear) and during increased ICP (1 ear), and in humans during changes of the postural position to alter the ICP (4 ears). In both CHL and elevated ICP, DPOAE levels are not only reduced, but LDP versus L1 growth functions exhibit a shift to higher L1. The absolute DPOAE level alterations strongly depend on the L2,L1 combinations and the individual shape of the LDP versus L1 growth functions. In steeper LDP versus L1 growth functions, the DPOAE level alterations exhibit a larger variation. DPOAE levels can even increase. The largest variation can be found in ears with a nonmonotonic DPOAE growth behavior. An example of a guinea pig ear is presented with a nonmonotonic DPOAE growth

  17. 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....

  18. Pattern of pressure gradient alterations after venous sinus stenting for idiopathic intracranial hypertension predicts stent-adjacent stenosis: a proposed classification system.

    Science.gov (United States)

    Raper, Daniel; Buell, Thomas J; Ding, Dale; Chen, Ching-Jen; Starke, Robert M; Liu, Kenneth C

    2018-04-01

    Venous sinus stenting (VSS) is a safe and effective treatment for idiopathic intracranial hypertension (IIH) with angiographic venous sinus stenosis. However, predictors of stent-adjacent stenosis (SAS) remain poorly defined. We performed a retrospective review of 47 patients with IIH and intracranial venous stenosis who underwent VSS with pre- and post-stent venography. Patient characteristics, treatments and outcomes were reviewed. Changes in pressure gradient after VSS were classified according to pattern of gradient resolution into types I-III. Type I gradient resolution, in which mean venous pressure (MVP) in the transverse sinus (TS) decreases towards MVP in the sigmoid sinus (SS), occurred in 18 patients (38.3%). Type II gradient resolution pattern, in which SS MVP increases towards that in the TS, occurred in 7patients (14.9%). Type III pattern, in which MVP equilibrates to a middle value, occurred in 22patients (46.8%). SAS occurred in 0%, 28.6%, and 22.7% of patients in types I, II and III, respectively. Compared with patients with type I gradient resolution, SAS was more common in those with type II (p=0.0181) and type III (p=0.0306) patterns. The pattern of change in the trans-stenosis venous pressure gradient may be predictive of SAS and is a useful tool for classifying the response of the venous obstruction to stenting. A type I pattern appears to represent the ideal response to VSS. Some patients with type II and III changes, particularly if they have other predictors of recurrent stenosis, may benefit from longer initial stent constructs. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. Improved diagnostic value of a TCD-based non-invasive ICP measurement method compared with the sonographic ONSD method for detecting elevated intracranial pressure.

    Science.gov (United States)

    Ragauskas, Arminas; Bartusis, Laimonas; Piper, Ian; Zakelis, Rolandas; Matijosaitis, Vaidas; Petrikonis, Kestutis; Rastenyte, Daiva

    2014-07-01

    To compare the diagnostic reliability of optic nerve sheath diameter (ONSD) ultrasonography with a transcranial Doppler (TCD)-based absolute intracranial pressure (ICP) value measurement method for detection of elevated ICP in neurological patients. The ONSD method has been only tested previously on neurosurgical patients. A prospective clinical study of a non-invasive ICP estimation method based on ONSD correlation with ICP and an absolute ICP value measurement method based on a two-depth TCD technology has recruited 108 neurological patients. Ninety-two of these patients have been enrolled in the final analysis of the diagnostic reliability of ONSD ultrasonography and 85 patients using the absolute ICP value measurement method. All non-invasive ICP measurements were compared with 'Gold Standard' invasive cerebrospinal fluid (CSF) pressure measurements obtained by lumbar puncture. Receiver-operating characteristic (ROC) analysis has been used to investigate the diagnostic value of these two methods. The diagnostic sensitivity, specificity, and the area under the ROC curve (AUC) of the ONSD method for detecting elevated intracranial pressure (ICP >14·7 mmHg) were calculated using a cutoff point of ONSD at 5·0 mm and found to be 37·0%, 58·5%, and 0·57, respectively. The diagnostic sensitivity, specificity, and AUC for the non-invasive absolute ICP measurement method were calculated at the same ICP cutoff point of 14·7 mmHg and were determined to be 68·0%, 84·3%, and 0·87, respectively. The non-invasive ICP measurement method based on two-depth TCD technology has a better diagnostic reliability on neurological patients than the ONSD method when expressed by the sensitivity and specificity for detecting elevated ICP >14·7 mmHg.

  20. 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...

  1. External Ventricular Catheters: Is It Appropriate to Use an Open/Monitor Position to Adequately Trend Intracranial Pressure in a Neuroscience Critical Care Environment?

    Science.gov (United States)

    Sunderland, Nicole E; Villanueva, Nancy E; Pazuchanics, Susan J

    2016-10-01

    Intracranial pressure (ICP) monitoring can be an important assessment tool in critically and acutely ill patients. An external ventricular drain offers a comprehensive way to monitor ICP and drain cerebrospinal fluid. The Monro-Kellie hypothesis, Pascal's principle, and fluid dynamics were used to formulate an assumption that an open/monitor position on the stopcock is an adequate trending measure for ICP monitoring while concurrently draining cerebrospinal fluid. Data were collected from 50 patients and totaled 1053 separate number sets. The open/monitor position was compared with the clamped position every hour. An order for "open to drain" was needed for appropriate measurement and nursing care. Results showed the absolute average differences between open/monitor and clamped positions at 1.6268 mm Hg. This finding suggests that it is appropriate to use an open/monitor position via an external ventricular drain for adequate trending of patients' ICP.

  2. 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.

  3. European society of intensive care medicine study of therapeutic hypothermia (32-35°C for intracranial pressure reduction after traumatic brain injury (the Eurotherm3235Trial

    Directory of Open Access Journals (Sweden)

    Stocchetti Nino

    2011-01-01

    Full Text Available Abstract Background Traumatic brain injury is a major cause of death and severe disability worldwide with 1,000,000 hospital admissions per annum throughout the European Union. Therapeutic hypothermia to reduce intracranial hypertension may improve patient outcome but key issues are length of hypothermia treatment and speed of re-warming. A recent meta-analysis showed improved outcome when hypothermia was continued for between 48 hours and 5 days and patients were re-warmed slowly (1°C/4 hours. Previous experience with cooling also appears to be important if complications, which may outweigh the benefits of hypothermia, are to be avoided. Methods/design This is a pragmatic, multi-centre randomised controlled trial examining the effects of hypothermia 32-35°C, titrated to reduce intracranial pressure Participants are randomised to either standard care or standard care with titrated therapeutic hypothermia. Hypothermia is initiated with 20-30 ml/kg of intravenous, refrigerated 0.9% saline and maintained using each centre's usual cooling technique. There is a guideline for detection and treatment of shivering in the intervention group. Hypothermia is maintained for at least 48 hours in the treatment group and continued for as long as is necessary to maintain intracranial pressure 20 mmHg in accordance with the Brain Trauma Foundation Guidelines, 2007. Discussion The Eurotherm3235Trial is the most important clinical trial in critical care ever conceived by European intensive care medicine, because it was launched and funded by the European Society of Intensive Care Medicine and will be the largest non-commercial randomised controlled trial due to the substantial number of centres required to deliver the target number of patients. It represents a new and fundamental step for intensive care medicine in Europe. Recruitment will continue until January 2013 and interested clinicians from intensive care units worldwide can still join this important

  4. 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

  5. Intracranial haemorrhage

    African Journals Online (AJOL)

    Consultant Neurosurgeon, Division of Neurosurgery, University of Cape Town and Groote Schuur Hospital, Cape Town. David Le Feuvre .... evacuation. This, together with criticism of various limitations of the STICH trial, has led to the initiation of STICH II.[19]. Intracranial haematomas may also be dealt with during another ...

  6. 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 ...

  7. The association between the pulse pressure gradient at the cranio-cervical junction derived from phase-contrast magnetic resonance imaging and invasively measured pulsatile intracranial pressure in symptomatic patients with Chiari malformation type 1.

    Science.gov (United States)

    Frič, Radek; Lindstrøm, Erika Kristina; Ringstad, Geir Andre; Mardal, Kent-André; Eide, Per Kristian

    2016-12-01

    In symptomatic Chiari malformation type 1 (CMI), impaired intracranial compliance (ICC) is associated with an increased cranio-spinal pulsatile pressure gradient. Phase-contrast magnetic resonance imaging (MRI) represents a non-invasive modality for the assessment of the pulse pressure gradient at the cranio-cervical junction (CCJ). We wished to explore how the MRI-derived pulse pressure gradient (MRI-dP) compares with invasively measured pulsatile intracranial pressure (ICP) in CMI, and with healthy controls. From phase-contrast MRI of CMI patients and healthy controls, we computed cerebrospinal fluid (CSF) flow velocities and MRI-dP at the CCJ. We assessed bidirectional flow and compared the flow between the anterior and the posterior subarachnoid space at the CCJ. We computed total intracranial volume (ICV), ventricular CSF volume (VV), and posterior cranial fossa volume (PCFV). We analyzed the static and pulsatile ICP scores from overnight monitoring in CMI patients. Five CMI patients and four healthy subjects were included. The CMI group had a significantly larger extent of tonsillar ectopia, smaller PCFV, and a smaller area of CSF in the FM. The pulsatile ICP (mean ICP wave amplitude, MWA) was abnormally increased in 4/5 CMI patients and correlated positively with MRI-dP. However, the MRI-dP as well as the CSF flow velocities did not differ significantly between CMI and healthy subjects. Moreover, bidirectional flow was observed in both CMI as well as healthy subjects, with no significant difference. In symptomatic CMI patients, we found a significant association between the pulse pressure gradient at the CCJ derived from phase-contrast MRI and the pulsatile ICP (MWA) measured invasively. However, the MRI-dP was close to identical in CMI patients and healthy subjects. Moreover, the CSF flow velocities at the CCJ and the occurrence of bidirectional flow were not different in CMI patients and healthy individuals. Further studies are required to determine the

  8. Intracranial lipomas

    International Nuclear Information System (INIS)

    Hayashi, Takashi; Shojima, Kazuhito; Moritaka, Kazuhiko; Utsunomiya, Hidetsuna; Konishi, Jun

    1984-01-01

    Intracranial lipomas are very rare and reports of infantile lipomas are scarce. Nine cases of intracranial lipomas, five in infants and four in adults are described and characteristic findings of the CT are presented. Two of the six cases involved lipomas at the corpus callosum that were associated with frontal dysraphism and cranium bifidum at the midline of frontal region. Five of the nine cases involved lipomas at the quadrigeminal cistern. In one case with an advanced enlargement in circumference of the head in the perinatal period, a V-P shunt was conducted for obstructive hydrocephalus. Another case had widely ranging agenesis of the corpus callosum associated with an interhemispheric cyst showing the right sided parietal and occipital lobes through the callosal agenesis. One of the nine cases had a lipoma in the left sylvian fissure and in the adult was in the interpeduncular cistern. Four of the nine cases were associated with agenesis of the corpus callosum. Based on these cases and published reports, the CT features of intracranial lipoma are discussed. (author)

  9. 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.

  10. 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 ...

  11. Cryptococcus neoformans ex vivo capsule size is associated with intracranial pressure and host immune response in HIV-associated cryptococcal meningitis.

    Science.gov (United States)

    Robertson, Emma J; Najjuka, Grace; Rolfes, Melissa A; Akampurira, Andrew; Jain, Neena; Anantharanjit, Janani; von Hohenberg, Maximilian; Tassieri, Manlio; Carlsson, Allan; Meya, David B; Harrison, Thomas S; Fries, Bettina C; Boulware, David R; Bicanic, Tihana

    2014-01-01

    The Cryptococcus neoformans polysaccharide capsule is a well-characterized virulence factor with immunomodulatory properties. The organism and/or shed capsule is postulated to raise intracranial pressure (ICP) in cryptococcal meningitis (CM) by mechanical obstruction of cerebrospinal fluid (CSF) outflow. Little is known regarding capsule phenotype in human cryptococcosis. We investigated the relationship of ex vivo CSF capsular phenotype with ICP and CSF immune response, as well as in vitro phenotype. In total, 134 human immunodeficiency virus (HIV)-infected Ugandan adults with CM had serial lumbar punctures with measurement of CSF opening pressures, quantitative cultures, ex vivo capsule size and shedding, viscosity, and CSF cytokines; 108 had complete data. Induced capsular size and shedding were measured in vitro for 48 C. neoformans isolates. Cryptococcal strains producing larger ex vivo capsules in the baseline (pretreatment) CSF correlated with higher ICP (P = .02), slower rate of fungal clearance (P = .02), and paucity of CSF inflammation, including decreased CSF white blood cell (WBC) count (P Cryptococcal capsule size ex vivo is an important contributor to virulence in human cryptococcal meningitis.

  12. 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.

  13. Cerebral Abcess and Intracranial Empyemas in Children (Francais ...

    African Journals Online (AJOL)

    And in both cases because of brain herniation secondary to severe raised intracranial pressure. We observed no recurrence of pus collection. Neurological sequelae was observed in 8 cases. Conclusion Intracranial subdural empyemas are most common form of intracranial suppurations seen in children in our unit.

  14. 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 intracr......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...... to normalization of the intracranial pressure and resorption of the intracranial hemorrhage....

  15. 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...... 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....

  16. Artificial neural networks can be effectively used to model changes of intracranial pressure (ICP) during spinal surgery using different non invasive ICP surrogate estimators.

    Science.gov (United States)

    Watad, Abdulla; Bragazzi, Nicola L; Bacigaluppi, Susanna; Amital, Howard; Watad, Samaa; Sharif, Kassem; Bisharat, Bishara; Siri, Anna; Mahamid, Ala; Abu Ras, Hakim; Nasr, Ahmed; Bilotta, Federico; Robba, Chiara; Adawi, Mohammad

    2018-02-23

    Artificial Intelligence (AI) techniques play a major role in anesthesiology, even though their importance is often overlooked. In the extant literature, AI approaches, such as Artificial Neural Networks (ANNs), have been underutilized, mainly being used to model patient's consciousness state, to predict the precise amount of anesthetic gases, the level of analgesia, or the need of anesthesiological blocks, among others. In the field of neurosurgery, ANNs have been effectively applied to the diagnosis and prognosis of cerebral tumors, seizures, low back pain, and also to the monitoring of intracranial pressure (ICP). A MultiLayer Perceptron (MLP), which is a feedforward ANN, with hyperbolic tangent as activation function in the input/hidden layers, softmax as activation function in the output layer, and cross-entropy as error function, was used to model the impact of prone versus supine position and the use of positive end expiratory pressure (PEEP) on ICP in a sample of 30 patients undergoing spinal surgery. Different non invasive surrogate estimations of ICP have been used and compared: namely, mean optic nerve sheath diameter (ONSD), non invasive estimated cerebral perfusion pressure (NCPP), pulsatility index (PI), ICP derived from PI (ICP-PI), and flow velocity diastolic formula (FVDICP). ONSD proved to be a more robust surrogate estimation of ICP, with a predictive power of 75%, whilst the power of NCPP, ICP-PI, PI, and FVDICP were 60.5%, 54.8%, 53.1%, and 47.7%, respectively. Our MLP analysis confirmed our findings previously obtained with regression, correlation, multivariate Receiving Operator Curve (multi-ROC) analyses. ANNs can be successfully used to predict the effects of prone versus supine position and PEEP on ICP in patients undergoing spinal surgery using different non invasive surrogate estimators of ICP.

  17. Use of Near Infrared Transillumination / Back Scattering Sounding (NIR-T/BSS) to assess effects of elevated intracranial pressure on width of subarachnoid space and cerebrovascular pulsation in animals.

    Science.gov (United States)

    Frydrychowski, Andrzej F; Wszedybyl-Winklewska, Magdalena; Guminski, Wojciech; Przyborska, Agata; Kaczmarek, Jacek; Winklewski, Pawel J

    2011-01-01

    The objective was to assess changes in the width of the subarachnoid space (SAS) and amplitude of cerebrovascular pulsation (CVP) during acute elevation of intracranial pressure (ICP) using Near Infrared Transillumination/Back Scattering Sounding (NIR-T/BSS). Changes in the width of the SAS and amplitude of CVP were observed in rabbits during experimental ICP elevation induced by: (1) quick injections of saline into the subdural space of the spinal cord, and (2) distension of a surgical catheter balloon placed intracranially in the subdural space. The amplitude of CVP was also assessed during acute elevation of blood pressure in the intracranial portion of the internal carotid artery (ICA) induced by adrenaline. Each of the injections of saline caused a transient rise in the width of the SAS and amplitude of CVP. The amplitude of the increase in CVP was dependent on changes in blood pressure in the ICA (r=-0.82, P<0.01). Distension of the intracranial balloon resulted in elimination of the respiratory oscillations in the CVP and increased its systolic-diastolic amplitude. An increase in the amplitude of CVP was evoked by adrenaline without an increase in the carotid blood flow. We demonstrated that during elevation of ICP the amplitude of CVP depends on blood pressure rather than on blood flow in large cerebral vessels. Elimination of the respiratory oscillations by a minute ("sub-critical") ICP increase may be used as an early indicator of rising ICP. The direction of changes recorded using NIR-T/BSS was consistent with changes recorded using tensometric transducers.

  18. Hemorrhage rates of external ventricular drain (EVD), intracranial pressure gauge (ICP) or combined EVD and ICP gauge placement within 48 h of endovascular coil embolization of cerebral aneurysms.

    Science.gov (United States)

    Scholz, Christoph; Hubbe, Ulrich; Deininger, Miriam; Deininger, Martin H

    2013-08-01

    In single patients with a cerebral aneurysm an external ventricular drain (EVD), an intracranial pressure (ICP) gauge or a combined EVD and ICP gauge placement is necessary after coil embolization and initiation of postprocedural anticoagulation. The aim of this study was to examine the hemorrhage rates of drain placement within 48 h after aneurysm coiling and under anticoagulation or antiplatelet therapy. We retrospectively analyzed hemorrhage rates of EVD, ICP gauge or combined EVD and ICP gauge placement in 27 patients within 48 h after coil embolization under different anticoagulation or antiplatelet schemes (heparin, acetylsalicylic acid, clopidogrel). In patients with continuous heparin via perfusor the application was stopped periprocedurally. The results were compared to literature. Four hemorrhages (14.8%) were observed. Three hemorrhages were petechial and one was by definition a larger hemorrhage with 8 mm×10 mm in diameter. EVD, ICP gauge or combined EVD and ICP gauge placements within 48 h after cerebral aneurysm coiling and under different anticoagulation or antiplatelet regimens seem to have no increased risk of hemorrhages compared to literature. Copyright © 2013 Elsevier B.V. All rights reserved.

  19. 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.

  20. Comparison of the applicability of rule-based and self-organizing fuzzy logic controllers for sedation control of intracranial pressure pattern in a neurosurgical intensive care unit.

    Science.gov (United States)

    Shieh, Jiann-Shing; Fu, Mu; Huang, Sheng-Jean; Kao, Ming-Chien

    2006-08-01

    This paper assesses the controller performance of a self-organizing fuzzy logic controller (SOFLC) in comparison with a routine clinical rule-base controller (RBC) for sedation control of intracranial pressure (ICP) pattern. Eleven patients with severe head injury undergoing different neurosurgeries in a neurosurgical intensive care unit (NICU) were divided into two groups. In all cases the sedation control periods lasted 1 h and assessments of propofol infusion rates were made at a frequency of once per 30 s. In the control group of 10 cases selected from 5 patients, a RBC was used, and in the experimental group of 10 cases selected from 6 patients, a self-organizing fuzzy logic controller was used. A SOFLC was derived from a fuzzy logic controller and allowed to generate new rules via self-learning beyond the initial fuzzy rule-base obtained from experts (i.e., neurosurgeons). The performance of the controllers was analyzed using the ICP pattern of sedation for 1 h of control. The results show that a SOFLC can provide a more stable ICP pattern by administering more propofol and changing the rate of delivery more often when rule-base modifications have been considered.

  1. Effects of intracranial pressure on the pial microcirculation in rats studied by a fiber-optic laser-Doppler anemometer microscope.

    Science.gov (United States)

    Seki, J; Sasaki, Y; Oyama, T; Yamamoto, J

    1999-01-01

    The fiber-optic laser-Doppler anemometer microscope (FLDAM) developed in our laboratory was applied to measure red cell velocity in individual pial microvessels in rats to determine the effect of intracranial pressure (ICP) on the pial microcirculation. The red cell velocity and the vessel diameter of pial microvessels were measured through a closed cranial window at controlled values of ICP between 0 and 50 mmHg. As ICP increased from 0 to 50 mmHg, the average relative diameter of venules with respect to the diameter at an ICP of 5 mmHg decreased from 1.18 +/- 0.12 (mean +/- SD) to 0.74 +/- 0.08 and the average relative velocity increased from 0.80 +/- 0.20 to 1.83 +/- 0.42 monotonically. The changes in diameter and velocity of arterioles with ICP were small, and they were not significantly different from those values at an ICP of 5 mmHg except for the diameter at an ICP of 20 mmHg. The mean volume flow rates calculated assuming a circular vessel cross-section did not show any statistically significant change with ICP between 0 and 50 mmHg in both arterioles and venules, which supports the concept of autoregulation.

  2. 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...

  3. 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

  4. 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...... intracranial hypertension (IIH). RESULTS: Mean blood flow was 443 ml/min in healthy volunteers with a tendency towards reduced blood flow with increasing age. In NPH patients significantly lower superior sagittal sinus blood flow values were found, but this difference was no longer significant when patients...

  5. Temporal profile of intracranial pressure and cerebrovascular reactivity in severe traumatic brain injury and association with fatal outcome: An observational study.

    Directory of Open Access Journals (Sweden)

    Hadie Adams

    2017-07-01

    Full Text Available Both intracranial pressure (ICP and the cerebrovascular pressure reactivity represent the dysregulation of pathways directly involved in traumatic brain injury (TBI pathogenesis and have been used to inform clinical management. However, how these parameters evolve over time following injury and whether this evolution has any prognostic importance have not been studied.We analysed the temporal profile of ICP and pressure reactivity index (PRx, examined their relation to TBI-specific mortality, and determined if the prognostic relevance of these parameters was affected by their temporal profile using mixed models for repeated measures of ICP and PRx for the first 240 hours from the time of injury. A total of 601 adults with TBI, admitted between September 2002 to January 2016, and with high-resolution continuous monitoring from a single centre, were studied. At 6 months postinjury, 133 (19% patients had a fatal outcome; of those, 88 (78% died from nonsurvivable TBI or brain death. The difference in mean ICP between those with a fatal outcome and functional survivors was only significant for the first 168 hours after injury (all p < 0.05. For PRx, those patients with a fatal outcome also had a higher (more impaired PRx throughout the first 120 hours after injury (all p < 0.05. The separation of ICP and PRx was greatest in the first 72 hours after injury. Mixed models demonstrated that the explanatory power of the PRx decreases over time; therefore, the prognostic weight assigned to PRx should similarly decrease. However, the ability of ICP to predict a fatal outcome remained relatively stable over time. As control of ICP is the central purpose of TBI management, it is likely that some of the information that is reflected in the natural history of ICP changes is no longer apparent because of therapeutic intervention.We demonstrated the temporal evolution of ICP and PRx and their relationship with fatal outcome, indicating a potential early

  6. 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

  7. 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.

  8. Idiopathic intracranial hypertension without papilledema in children: A case series

    Directory of Open Access Journals (Sweden)

    Kaliopy Matheos

    2015-05-01

    Full Text Available Papilledema has long been considered a hallmark of idiopathic intracranial hypertension, a disease defined by elevated intracranial pressure with indiscernible etiology. Papilledema is often seen in the pediatric population, and as such can lead to delays in diagnosis, and often misdiagnosis. Here, we describe three children who were confirmed to have idiopathic intracranial hypertension with raised intracranial pressure by repeated lumbar puncture or intracranial pressure monitoring, normal neuroimaging and absence of papilledema. All three cases had atypical clinical presentations with visual disturbances or photophobia. The patients had a normal body mass index. This case series demonstrates that idiopathic intracranial hypertension can manifest in the absence of clinically obvious papilledema, and has, as such, the potential to cause permanent visual loss if the diagnosis is missed.

  9. 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...

  10. 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...

  11. 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

  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. 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...

  14. 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.

  15. Report on the second Intracranial Hypertension Research Foundation conference

    Directory of Open Access Journals (Sweden)

    Tanne Emanuel

    2008-08-01

    Full Text Available Abstract This report highlights a conference designed for patient education on elevated cerebrospinal fluid (CSF pressure. The conference centered on chronic intracranial hypertension (IH including the latest research and clinical information. It was sponsored by the Intracranial Hypertension Research Foundation and held at the University of Texas Medical School, Houston, on June 21–22nd, 2008.

  16. Genetic Determinants of Unruptured Intracranial Aneurysms in the General Population.

    Science.gov (United States)

    Peymani, Abbas; Adams, Hieab H H; Cremers, Lotte G M; Krestin, Gabriel; Hofman, Albert; van Duijn, Cornelia M; Uitterlinden, André G; van der Lugt, Aad; Vernooij, Meike W; Ikram, M Arfan

    2015-10-01

    Genome-wide association studies have identified single-nucleotide polymorphisms (SNPs) for intracranial aneurysms in clinical samples. In addition, SNPs have been discovered for blood pressure, one of the strongest risk factors for intracranial aneurysms. We studied the role of these genetic variants on occurrence and size of unruptured intracranial aneurysms, discovered incidentally in a general community-dwelling population. In 4890 asymptomatic participants from the Rotterdam Study, 120 intracranial aneurysms were identified on brain imaging and segmented for maximum diameter and volume. Genetic risk scores (GRS) were calculated for intracranial aneurysms (10 SNPs), systolic blood pressure (33 SNPs), and diastolic blood pressure (41 SNPs). The GRS for intracranial aneurysms was not statistically significantly associated with presence of aneurysms in this population (OR, 1.16; 95% CI, 0.96-1.40; P=0.119), but showed a significant association with both maximum diameter (difference in log-transformed mm per SD increase of GRS, 0.10; 95% CI, 0.02-0.19; P=0.018) and volume (difference in log-transformed µL per SD increase of GRS, 0.21; 95% CI, 0.01-0.41; P=0.040) of aneurysms. GRSs for blood pressures were associated with neither presence nor size of aneurysms. Genetic variants previously identified for intracranial aneurysms in clinical studies relate to the size rather than the presence of incidentally discovered, unruptured intracranial aneurysms in the general population. © 2015 American Heart Association, Inc.

  17. Prevention and treatment of intracranial hypertension.

    Science.gov (United States)

    Jantzen, Jan-Peter A H

    2007-12-01

    Intracranial pressure (ICP) is the pressure exerted by cranial contents on the dural envelope. It comprises the partial pressures of brain, blood and cerebrospinal fluid (CSF). Normal intracranial pressure is somewhere below 10 mmHg; it may increase as a result of traumatic brain injury, stroke, neoplasm, Reye's syndrome, hepatic coma, or other pathologies. When ICP increases above 20 mmHg it may damage neurons and jeopardize cerebral perfusion. If such a condition persists, treatment is indicated. Control of ICP requires measurement, which can only be performed invasively. Standard techniques include direct ventricular manometry or measurement in the parenchyma with electronic or fiberoptic devices. Displaying the time course of pressure (high-resolution ICP tonoscopy) allows assessment of the validity of the signal and identification of specific pathological findings, such as A-, B- and C-waves. When ICP is pathologically elevated--at or above 20-25 mmHg--it needs to be lowered. A range of treatment modalities is available and should be applied with consideration of the underlying cause. When intracranial hypertension is caused by hematoma, contusion, tumor, hygroma, hydrocephalus or pneumatocephalus, surgical treatment is indicated. In the absence of a surgically treatable condition, ICP may be controlled by correcting the patient's position, temperature, ventilation or hemodynamics. If intracranial hypertension persists, drainage of CSF via external drainage is most effective. Other first-tier options include induced hypocapnea (hyperventilation; paCO2 < 35 mmHg), hyperosmolar therapy (mannitol, hypertonic saline) and induced arterial hypertension (CPP concept). When autoregulation of cerebral blood flow is compromised, hyperoncotic treatment aimed at reducing vasogenic edema and intracranial blood volume may be applied. When intracranial hypertension persists, second-tier treatments may be indicated. These include 'forced hyperventilation' (paCO2 < 25 mm

  18. 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.

  19. Unruptured intracranial aneurysms

    NARCIS (Netherlands)

    Backes, D

    2016-01-01

    Rupture of an intracranial aneurysm results in aneurysmal subarachnoid hemorrhage (SAH), a subtype of stroke with an incidence of 9 per 100,000 person-years and a case-fatality around 35%. In order to prevent SAH, patients with unruptured intracranial aneurysms can be treated by neurosurgical or

  20. 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.

  1. Cognitive function in idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Yri, Hanne Maria; Fagerlund, Birgitte; Forchhammer, Hysse Birgitte

    2014-01-01

    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 and a terti......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...... and a tertiary headache referral clinic at a Danish university hospital. PARTICIPANTS: 31 patients with definite IIH referred from June 2011 to February 2013 and included within 1 week of diagnostic intracranial pressure (ICP) measurement. 29 patients completed re-examination at the 3-month follow...

  2. 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.

  3. Magnetic resonance "flip-flop" in idiopathic intracranial hypertension

    Directory of Open Access Journals (Sweden)

    Uttam George

    2011-01-01

    Full Text Available Idiopathic intracranial hypertension (IIH is a headache syndrome with raised CSF pressure in the absence of an intracranial mass lesion. Though earlier confined to excluding intracranial lesions, magnetic resonance imaging (MRI in recent years has been shown to identify intracranial changes from prolonged raised CSF pressure, suggestive of IIH. We present the MRI and TOF (time-of-flight venography findings involving the orbit, sella tursica and cerebral venous structures in a 45-year-old lady with IIH and illustrate their reversibility ("flip-flop" following CSF drainage. Our case highlights the role of imaging in evaluation and follow-up of patients with IIH, without the need for repeated lumbar punctures to monitor pressures.

  4. 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.

  5. Understanding the Effects of Blast Wave on the Intracranial Pressure and Traumatic Brain Injury in Rodents and Humans Using Experimental Shock Tube and Numerical Simulations

    Science.gov (United States)

    2014-07-01

    infant brain makes it more susceptible to TBI [75]. In 2006, Mao developed an anatomically detailed high-resolution finite element model of the rat...Zhu in 2011 developed a rat head model based on a previous rat brain model by Mao and his colleagues for simulating a blunt controlled cortical impact...percent increase in lung mass, P: Any characteristic pressure of the pulse occurring in the lungs, such as peak pressure, Po: Ambient pressure, t: Any

  6. Natriuretic pro-peptides in idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Skau, Maren Cecilie Kloppenbor; Gøtze, Jens Peter; Rehfeld, Jens F.

    2010-01-01

    Idiopathic intracranial hypertension is a disorder of unknown pathogenesis. Natriuretic peptides may be involved in intracranial pressure regulation, but cerebrospinal fluid (CNS) and plasma concentrations in this disorder are unknown. We evaluated venous and intrathecal concentrations of ANP, BNP...... and CNP precursor peptides in 40 patients with idiopathic intracranial hypertension and in 20 controls. Natriuretic pro-peptides were quantitated using processing-independent assays. In CSF, no differences in peptide concentrations between patients and controls were found (proANP: 239 + or - 23 vs 231...

  7. Intracranial Hypertension: Medication and Surgery

    Science.gov (United States)

    ... have little effect on headaches caused by intracranial hypertension, they may temporarily affect the intensity of a ... study in which 26 patients with idiopathic intracranial hypertension (IIH) were treated with octreotide, a synthetic hormone ...

  8. 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....

  9. 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; 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)

  10. Highlighting intracranial pressure monitoring in patients with severe acute brain trauma Ressaltando a monitorização da pressão intracraniana em pacientes com traumatismo cerebral agudo grave

    Directory of Open Access Journals (Sweden)

    Antonio L. E Falcão

    1995-09-01

    Full Text Available Intracranial pressure (ICP monitoring was carried out in 100 patients with severe acute brain trauma, primarily by means of a subarachnoid catheter. Statistical associations were evaluated between maximum ICP values and: 1 Glasgow Coma Scale (GCS scores; 2 findings on computed tomography (CT scans of the head; and 3 mortality. A significant association was found between low GCS scores (3 to 5 and high ICP levels, as well as between focal lesions on CT scans and elevated ICP. Mortality was significantly higher in patients with ICP > 40 mm Hg than in those with ICP Monitorização da pressão intracraniana (PIC foi adotada em 100 pacientes com traumatismo cerebral agudo grave, usando-se preferencialmente um catéter subaracnóide. Associações estatísticas foram avaliadas entre valores máximos de PIC e : 1 número de pontos na Escala de Coma de Glasgow (ECG; 2 achados na tomografia computadorizada (TC da cabeça; e 3 mortalidade. Encontrou-se associação significante entre baixo número de pontos (3 a 5 na ECG e PIC elevada, assim como entre lesões focais na TC e hipertensão intracraniana. A mortalidade foi significantemente maior em pacientes com PIC > 40 mm Hg do que naqueles com PIC < 20 mm Hg.

  11. Intracranial atherosclerosis following radiotherapy

    International Nuclear Information System (INIS)

    Werner, M.H.; Burger, P.C.; Heinz, E.R.; Friedman, A.H.; Halperin, E.C.; Schold, S.C. Jr.

    1988-01-01

    We describe a case of severe intracranial atherosclerosis in a young man who had received therapeutic radiation for a presumed brain neoplasm. Since there was no evidence of vascular disease outside the radiation ports, we speculate that accelerated atherosclerosis was induced by radiation and that hyperlipidemia may have predisposed him to this effect

  12. Intracranial artery dissection

    NARCIS (Netherlands)

    Sikkema, T.; Uyttenboogaart, Maarten; Eshghi, O.; De Keyser, J.; Brouns, R.; van Dijk, J.M.C.; Luijckx, G. J.

    The aim of this narrative review is to evaluate the pathogenesis, clinical features, diagnosis, treatment and prognosis of intracranial artery dissection (IAD). IAD is a rare and often unrecognized cause of stroke or subarachnoid haemorrhage (SAH), especially in young adults. Two types of IAD can be

  13. 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.)

  14. 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.).

  15. Sixth Nerve Palsy in Paediatric Intracranial Hypertension.

    Science.gov (United States)

    Reid, Julia E; Reem, Rachel E; Aylward, Shawn C; Rogers, David L

    2016-02-01

    The purpose of this study was to report the incidence and describe the characteristics of sixth cranial nerve (CN VI) palsy in paediatric patients with intracranial hypertension (IH). A retrospective chart review of central Ohio children diagnosed with IH over the 3-year period from 2010 to 2013 was conducted. IH without identifiable cause was defined as idiopathic intracranial hypertension (IIH), whereas IH with identifiable pathologic aetiology was deemed secondary intracranial hypertension (SIH). A subset of patients with CN VI palsy was identified. Data collected included patient age, gender, past medical history, aetiology of SIH, ophthalmic examination, lumbar puncture results, neuroimaging results, and response to treatment. Seventy-eight children with intracranial hypertension were included in the study. Nine (11.5%) children (four males, five females; median age 14, range: 3-18) were found to have a unilateral ( n = 2) or bilateral ( n = 7) CN VI palsy. Five children had IIH; the remaining four had SIH from cerebral venous sinus thrombosis ( n = 2) and infection ( n = 2). The mean lumbar puncture opening pressure for the nine patients with CN VI palsy was 40 cm H 2 O (range: 21-65 cm H 2 O). Papilloedema was present in 8/9 (89%) patients. One patient required a lumboperitoneal shunt, and two others required optic nerve sheath fenestrations in addition to medical management. All cases of CN VI palsy resolved with treatment. In our primary service area, the incidence of CN VI palsy is approximately 12% among paediatric IH patients. The majority of cases with CN VI palsy presented with papilloedema and all cases resolved with treatment of intracranial hypertension.

  16. 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.

  17. 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

  18. 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,

  19. 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.

  20. 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.

  1. 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.

  2. Hindlimb Suspension (HLS) in Rodents for the Study of Intracranial Pressure, Molecular and Histologic Changes in the Eye, and CSF Production Regulation and Resorption: A Status Report of Two Studies

    Science.gov (United States)

    Theriot, C. A.; Taibbi, G.; Vizzeri, G.; Parsons-Wingerter, P.; Chevez-Barrios, P.; Rivera, A.; Zanello, S. B.

    2016-01-01

    This status report corresponds to two studies tied to an animal experiment being executed at the University of California Davis (Charles Fuller's laboratory). The animal protocol uses the well-documented rat hindlimb suspension (HLS) model, to examine the relationship between cephalic fluid shifts and the regulation of intracranial (ICP) and intraocular (IOP) pressures as well as visual system structure and function. Long Evans rats are subjected to HLS durations of 7, 14, 28 and 90 days. Subgroups of the 90-day animals are studied for recovery periods of 7, 14, 28 or 90 days. All HLS subjects have age-matched cage controls. Various animal cohorts are planned for this study: young males, young females and old males. In addition to the live measures (ICP by telemetry, IOP and retinal parameters by optical coherence tomography) which are shared with the Fuller study, the specific outcomes for this study include: -Gene expression analysis of the retina -Histologic analysis - Analysis of the microvasculature of retina flat mounts by NASA's VESsel GENeration Analysis (VESGEN) Software. To date, the young male and female cohorts are being completed. Due to the need to keep technical variation to a minimum, the histologic and genomic analyses have been delayed until all samples from each cohort are available and can be processed in a single batch per cohort. The samples received so far correspond to young males sacrificed at 7,14, 28 and 90 days of HLS and at 90 days of recovery; and from young females sacrificed at 7, 14 and 28 of HLS. A complementary study titled: "A gene expression and histologic approach to the study of cerebrospinal fluid (CSF) production and outflow in hindlimb suspended rats" seeks to study the molecular components of CSF production and outflow modulation as a result of HLS, bringing a molecular and histologic approach to investigate genome wide expression changes in the arachnoid villi and choroid plexus of HLS rats compared to rats in normal

  3. The relationship between computed tomography measurement of the optic nerve sheath diameter and elevated intracranial pressure in non-trauma patients

    Directory of Open Access Journals (Sweden)

    Daniël Luyt

    2016-11-01

    Objective: The purpose of this study was to determine if the ONSD can be measured on digital images obtained by routine CT investigations of the brain, to identify patients with non-traumatic causes of elevated ICP, and to provide the observer with a non-invasive, objective measurement to predict elevated ICP. Method: We conducted a cross-sectional, retrospective analysis of anonymised patient data, comparing the ONSD on CT imaging with the opening pressure manometry during LP on patients who presented with focal neurology or with a Glasgow coma scale score of less than 15. The study sample consisted of 67 patients, ≥18 years of age, treated at the emergency department of the Kimberly Hospital Complex from 01 March 2013 to 31 December 2014. Results: An ONSD measurement of ≥4.8 mm identified patients with an elevated ICP with a sensitivity of 92.9% and a specificity of 97.6%, using a 95% confidence interval. Raising the ONSD cut-off value to ≥5.0 mm decreased the sensitivity to 85.7% but increased the specificity to 100%, eliminating all patients with a normal ICP. Conclusion: The ONSD can be measured on digital images obtained by routine CT investigations of the brain to predict elevated ICP in non-trauma patients, ≥18 years of age, with acceptable sensitivity and specificity.

  4. 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...

  5. 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...... and subcortical abscesses in combination with sinusitis. She was treated with endoscopic sinus surgery and intravenous antibiotics. Both patients had developed psoriasis and episodes of infection during treatment. They were non-septic and had low fever on presentation. None of the patients suffered any long...

  6. 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.

  7. 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

  8. 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.

  9. Ciclosporin does not attenuate intracranial hypertension in rats with acute hyperammonaemia

    DEFF Research Database (Denmark)

    Larsen, Rikke Hebo; Kjær, Mette S; Eefsen, Martin

    2013-01-01

    To investigate the neuroprotective potential of ciclosporin during acute liver failure. We evaluated the effect of intrathecally administered ciclosporin on intracranial pressure, brain water content and aquaporin-4 expression in a rat model with acute hyperammonaemia....

  10. 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

  11. Biomarkers Prognostic for Elevated Intracranial Pressure

    Science.gov (United States)

    2016-03-01

    male who was involved in a high-speed motorcycle collision without helmet who had a positive loss of consciousness per emergency medicine services...12:50. CC-TBI-075 was a 61-year-old male involved in a motorcycle collision without a helmet on 4/19/2013. The patient was a GCS of 6 at the scene...0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law

  12. 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...

  13. 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...... was inserted since the patient had improved with CSF diversion. MRI verified reopening of the venous sinuses after shunt placement, and the patient remains asymptomatic with no signs of relapse after 3 years of follow-up....

  14. 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.

  15. Meningiomas among intracranial neoplasms in Johannesburg ...

    African Journals Online (AJOL)

    Background: Worldwide there are varying reports on the prevalence of meningiomas among intracranial neoplasms. Different reports state intracranial meningiomas, gliomas or metastatic tumours as the most common tumour among intracranial neoplasms. We present our institutions' experience of patients with intracranial ...

  16. The course of headache in idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Yri, H M; Rönnbäck, C; Wegener, Marianne

    2014-01-01

    of the remaining 20 patients reported sustained chronic headache. Early age of onset and high diagnostic intracranial pressure (ICP) were associated with better headache outcome (≤1 headache days/month) after a year. Papilledema decreased rapidly within the first 2 months of diagnosis. After 1 year, OCT measures......BACKGROUND AND PURPOSE: Our aim was to prospectively describe the course of headache during the first year of idiopathic intracranial hypertension (IIH). METHODS: Patients with newly diagnosed IIH were consecutively included from December 2010 to June 2013. Treatment according to standard...

  17. Unruptured Intracranial Aneurysms

    Science.gov (United States)

    Raymond, J.; Guillemin, F.; Proust, F.; Molyneux, A.J.; Fox, A.J.; Claiborne, J.S.; Meder, J.-F.; Rouleau, I.

    2008-01-01

    Summary The preventive treatment of unruptured aneur­ysms has been performed for decades despite the lack of evidence of a clinical benefit. Reports of observational studies such as the International Study of Unruptured Intracranial Aneurysms (ISUIA) suggest that preventive treatments are rarely justified. Are these reports compelling enough to guide clinical practice? The ISUIA methods and data are reviewed and analysed in a more conventional manner. The design of the appropriate clinical research program is approached by steps, reviewing potential problems, from the formulation of the precise research question to the interpretation of subgroup analyses, including sample size, representativity, duration of observation period, blin­ding, definition of outcome events, analysis of cross-overs, losses to follow-up, and data reporting. Unruptured intracranial aneurysms observed in ISUIA ruptured at a minimal annual rate of 0.8% (0.5-1%), despite multiple methodological difficulties biased in favour of a benign natural history. Available registries do not have the power or the design capable of providing normative guidelines for clinical decisions. The appropriate method to solve the clinical dilemma is a multicentric trial comparing the incidence of a hard clinical outcome events in approximately 2000 patients randomly allocated to a treatment group and a deferred treatment group, all followed for ten years or more. Observational studies have failed to provide reliable evidence in favour or against the preventive treatment of unruptured aneurysms. A randomized trial is in order to clarify what is the role of prevention in this common clinical problem. PMID:20557790

  18. 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

  19. Intracranial atherosclerosis: Causes of ischemic stroke, diagnosis, and treatment

    Directory of Open Access Journals (Sweden)

    V.A Sorokoumov

    2014-01-01

    Full Text Available The paper reviews the literature on the identification of the causes of ischemic stroke and transient ischemic attacks in intracranial atherosclerosis. Symptomatic intracranial atherosclerosis is the cause of an ischemic focus in not only the cortical and subcortical structures due to hypoperfusion or arterio-arterial embolism, but also in the deep structures of the cerebral hemispheres and brainstem. Major artery dolichoectasia may make an accurate diagnosis and treatment choice difficult.Progress in the treatment of patients with symptomatic intracranial atherosclerosis depends on the availability of current brain and vessel imaging techniques and cranial artery angioplasty and stenting methods. The efficiency of aggressive medical prevention, primarily blood pressure reduction and different combinations of antiplatelet drugs, is being intensively investigated.

  20. Complete ophthalmoplegia: A rare presentation of idiopathic intracranial hypertension

    Directory of Open Access Journals (Sweden)

    Irfan Yousuf Wani

    2015-01-01

    Full Text Available Idiopathic intracranial hypertension (IIH is a disorder defined by clinical criteria that include signs and symptoms isolated to those produced by increased intracranial pressure (ICP; e. g., headache, papilledema, and vision loss, elevated ICP with normal cerebrospinal fluid (CSF composition, and no other cause of intracranial hypertension evident on neuroimaging or other evaluations. The most common signs in IIH are papilledema, visual field loss, and unilateral or bilateral sixth cranial nerve palsy. Here we report a case of IIH presenting as headache with vision loss, papilledema, complete ophthalmoplegia with proptosis in one eye, and sixth cranial nerve palsy in the other eye. Patient was managed with acetazolamide, topiramate, and diuretics. Symptoms remained static and she was planned for urgent CSF diversion procedure.

  1. Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)

    Science.gov (United States)

    ... post pubescent teenagers, tends to fit the adult stereotype. How is pediatric idiopathic intracranial hypertension diagnosed? If ... Subscribe to AOJ Allied Health Resources for School Nurses About AAPOS Our Association Staff Contacts Medical Disclaimer ...

  2. 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.

  3. 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

  4. 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

  5. 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.

  6. Modulação da pressão intracraniana em um modelo experimental de hipertensão abdominal e lesão pulmonar aguda Factors associated with variation in intracranial pressure in a model of intra-abdominal hypertension with acute lung injury

    Directory of Open Access Journals (Sweden)

    Fernando Godinho Zampieri

    2011-06-01

    Full Text Available OBJETIVO: Avaliar o efeito de alterações hemodinâmicas, respiratórias e metabólicas sobre a pressão intracraniana em um modelo de lesão pulmonar aguda e síndrome compartimental abdominal. MÉTODOS: Oito porcos Agroceres foram submetidos, após a instrumentação, a cinco cenários clínicos: 1 estado basal com baixa pressão intra-abdominal e pulmão sadio; 2 pneumoperitôneo, com pressão intra-abdominal de 20 mm Hg; 3 lesão pulmonar aguda induzida por lavagem pulmonar e desativação de surfactante; 4 pneumoperitôneo com pressão intra-abdominal de 20 mm Hg na vigência de lesão pulmonar aguda e com PEEP baixo; e 5 PEEP ajustado a 27 cm H2O na vigência de pneumoperitôneo e lesão pulmonar aguda. Variáveis respiratórias e hemodinâmicas foram coletadas. Análise multivariada foi realizada buscando as variáveis associadas com elevação da pressão intracraniana nos cinco cenários estudados. RESULTADOS: Após a análise multivariada, nas situações não associadas com lesão pulmonar aguda apenas a pressão de platô das vias aéreas se correlacionou positivamente com a pressão intracraniana. Nos modelos associados com lesão pulmonar aguda, a pressão de platô de vias aéreas, a pressão arterial de CO2, o CO2 no final da expiração e a pressão venosa central se correlacionaram positivamente com incrementos da pressão intracraniana. CONCLUSÃO: Em um modelo de disfunção orgânica múltipla com situações clínicas associadas com aumento da pressão torácica e abdominal, o incremento da pressão intracraniana desencadeado pela elevação da pressão abdominal parece ser decorrente da piora da complacência do sistema respiratório e da redução do gradiente para drenagem venosa cerebral ocasionado pela elevação da pressão venosa central.OBJECTIVE: To evaluate the effects of hemodynamic, respiratory and metabolic changes on intracranial pressure in a model of acute lung injury and abdominal compartment syndrome

  7. SEVERE BRAIN INJURIES: CORRELATION BETWEEN SURVIVAL AND INTRACRANIAL HYPERTENSION

    Directory of Open Access Journals (Sweden)

    Aleksandar Kostić

    2011-09-01

    Full Text Available There are several reasons of intracranial pressure (ICP increase in the brain trauma. Brain edema, due to the brain-blood bariere injury, contusion of brain tissue and intracranial hematomas that represent mass lesion, cerebrovascular autoregulation failure which leads to hemodinamic disorder, and traumatic subarchnoid haemorrhagae that is commonly associated with CSF flow disturbances are the main causes. The aim of our study was to examine the survival of patients with severe brain trauma in the presence of different values of ICP. This prospective study included 32 patients with intracranial pressure monitored, and appropriate treatment undertaken. Twenty-two patients (68.75% had elevated ICP, and in 10 patients (31,25% there were no criteria of intracranial hypertnesion (ICHTN. The results of our study showed that absolute lethal value of ICHTN is 50mmHg and over – none of the injured survived such ICP if lasted more than two hours, because of inevitable brain and brainstem ischemia and failure of the vital functions. The relatively lethal values of ICP ranged from 40 to 50mmHg, in the case of which we menaged to prevent a fatal outcome in one out of five cases.

  8. Long-term visual outcome in a Danish population of patients with idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Hatem, Christina F; Yri, Hanne M; Sørensen, Anne L

    2018-01-01

    PURPOSE: Idiopathic intracranial hypertension (IIH) is characterized by raised intracranial pressure (ICP), normal cerebrospinal composition and exclusion of alternative causes to increased ICP. The aim of this study was to evaluate long-term visual outcome in a Danish population of IIH patients...... of papilloedema decreased from 2.2 at V0 to 0.5 at V2. The grade of papilloedema at V2 was not significantly related to the severity of papilloedema at V0 (p-values 0.65 and 0.48). CONCLUSION: Idiopathic intracranial hypertension (IIH) is associated with long-term loss of visual function, and relevant treatment...

  9. 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....

  10. Intracranial dural metastases.

    Science.gov (United States)

    Nayak, Lakshmi; Abrey, Lauren E; Iwamoto, Fabio M

    2009-05-01

    : Intracranial dural metastases (IDM) are found at autopsy in 9% of patients with advanced systemic cancer. However, to the authors' knowledge, IDM have not been studied systematically in the modern neuroimaging era. The objective of the current study was to evaluate the demographics, clinical presentation, imaging, treatment, and prognosis of patients with IDM. : The current study was a retrospective review of 122 patients with IDM diagnosed at Memorial Sloan-Kettering Cancer Center between 1999 and 2006. Patients with concurrent brain or leptomeningeal metastases were excluded. : Sixty-one percent of the patients were women; the median age at diagnosis was 59 years, the median Karnofsky performance scale (KPS) at diagnosis was 80, and the median time to IDM diagnosis from initial cancer diagnosis was 37 months. Breast (34%) and prostate (17%) cancers were the most frequent primary tumors associated with IDM. Fifty-six percent of patients had a single dural metastasis. On imaging, 70% had metastases of the overlying skull, 44% had dural tail metastases, 53% had vasogenic edema, and 34% had brain invasion. Direct extension from skull metastases was the most common mode of spread. Eighty-three percent of patients had active systemic disease at the time of IDM diagnosis. A lower KPS and lung cancer were associated with worse overall survival. Surgical resection and chemotherapy improved progression-free survival, but only resection was found to be associated with improved overall survival. : IDM affect a significant proportion of cancer patients. KPS and status of systemic cancer should guide treatment decisions. Cancer 2009. (c) 2009 American Cancer Society.

  11. 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)

  12. 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....

  13. Transtentorial herniation caused by an intracranial mass lesion following high-dose methotrexate

    Energy Technology Data Exchange (ETDEWEB)

    Villareal, B.; Baum, L.G.; Vinters, H.V.; Feig, S.A. (Univ. of California, Los Angeles (USA))

    A patient with intracranial osteosarcoma that arose 16 years after radiation therapy for hereditary retinoblastoma developed fatal cerebral edema and brainstem herniation after she received a single dose of intravenous methotrexate. Autopsy demonstrated extensive necrosis of the tumor mass, as well as necrotizing vascular damage within the neoplasm. Although high-dose methotrexate has been shown to be useful in the treatment of primary osteogenic sarcoma, the tumoricidal effects of therapy appear to have caused a fatal rise in intracranial pressure.

  14. 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.)

  15. Cerebrospinal fluid pulse pressure and craniospinal dynamics : a theoretical, clinical and experimental study

    NARCIS (Netherlands)

    C.J.J. Avezaat (Cees); J.H.M. van Eijndhoven (Johannes Hubertus Marcellianus)

    1984-01-01

    textabstractSince the introduction of continuous recording of intracranial pressure (ICP) in neurosurgical practice (Guillaume and Janny, 1951; Lundberg, 1960) this method has greatly contributed to clinical research in the field of intracranial hypertension. Numerous publications have enriched the

  16. Management of Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Nasr, Deena M; Brown, Robert D

    2016-09-01

    Unruptured intracranial aneurysms (UIA) occur in approximately 2-3 % of the population. Most of these lesions are incidentally found, asymptomatic and typically carry a benign course. Although the risk of aneurysmal subarachnoid hemorrhage is low, this complication can result in significant morbidity and mortality, making assessment of this risk the cornerstone of UIA management. This article reviews important factors to consider when managing unruptured intracranial aneurysms including patient demographics, comorbidities, family history, symptom status, and aneurysm characteristics. It also addresses screening, monitoring, medical management and current surgical and endovascular therapies.

  17. Intracranial Vertebrobasilar Artery Dissection Associated with Postpartum Angiopathy

    Directory of Open Access Journals (Sweden)

    James S. McKinney

    2010-01-01

    Full Text Available Background. Cervicocephalic arterial dissection (CCAD is rare in the postpartum period. To our knowledge this is the first reported case of postpartum angiopathy (PPA presenting with ischemic stroke due to intracranial arterial dissection. Case. A 41-year-old woman presented with blurred vision, headache, and generalized seizures 5 days after delivering twins. She was treated with magnesium for eclampsia. MRI identified multiple posterior circulation infarcts. Angiography identified a complex dissection extending from both intradural vertebral arteries, through the basilar artery, and into both posterior cerebral arteries. Multiple segments of arterial dilatation and narrowing consistent with PPA were present. Xenon enhanced CT (Xe-CT showed reduced regional cerebral blood flow that is improved with elevation in blood pressure. Conclusion. Intracranial vertebrobasilar dissection causing stroke is a rare complication of pregnancy. Eclampsia and PPA may play a role in its pathogenesis. Blood pressure management may be tailored using quantitative blood flow studies, such as Xe-CT.

  18. Intracranial Vertebrobasilar Artery Dissection Associated with Postpartum Angiopathy

    Science.gov (United States)

    McKinney, James S.; Messé, Steven R.; Pukenas, Bryan A.; Satti, Sudhakar R.; Weigele, John B.; Hurst, Robert W.; Levine, Joshua M.; Kasner, Scott E.; Sansing, Lauren H.

    2010-01-01

    Background. Cervicocephalic arterial dissection (CCAD) is rare in the postpartum period. To our knowledge this is the first reported case of postpartum angiopathy (PPA) presenting with ischemic stroke due to intracranial arterial dissection. Case. A 41-year-old woman presented with blurred vision, headache, and generalized seizures 5 days after delivering twins. She was treated with magnesium for eclampsia. MRI identified multiple posterior circulation infarcts. Angiography identified a complex dissection extending from both intradural vertebral arteries, through the basilar artery, and into both posterior cerebral arteries. Multiple segments of arterial dilatation and narrowing consistent with PPA were present. Xenon enhanced CT (Xe-CT) showed reduced regional cerebral blood flow that is improved with elevation in blood pressure. Conclusion. Intracranial vertebrobasilar dissection causing stroke is a rare complication of pregnancy. Eclampsia and PPA may play a role in its pathogenesis. Blood pressure management may be tailored using quantitative blood flow studies, such as Xe-CT. PMID:20700423

  19. Intracranial hemorrhage: ultrasound, CT and MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Huisman, Thierry A.G.M. [University Children' s Hospital Zurich, Department of Diagnostic Imaging, Zurich (Switzerland)

    2005-03-01

    Intracranial hemorrhage is one of the most common causes of acute focal neurologic deficit in children and adults. Neuroimaging including ultrasonography (US), computer tomography (CT) and magnetic resonance imaging (MRI) is essential in the diagnosis of intracranial hemorrhage. Imaging findings should guide treatment. The highly variable appearance of an intracranial hemorrhage can be challenging. A thorough knowledge of hematoma evolution and US, CT and MR hematoma characteristics is mandatory for adequate interpretation of findings. The purpose of this review is (1) to summarize the imaging characteristics of intracranial hemorrhage on various imaging techniques and (2) to review the various types of intracranial hemorrhage, and their causes. (orig.)

  20. Haemorrhage in intracranial tuber- culosis

    African Journals Online (AJOL)

    Introduction. Intracranial tuberculosis is an important cause of morbidity and mortality in developing countries where tuberculosis is endemic.1 In the central nervous system tuberculosis manifests as cerebritis, cerebral abscess, tuberculoma, and tubercu- lous meningitis (TBM).1-5 TBM is thought to arise from cerebrospinal.

  1. 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.

  2. Imaging intracranial tuberculosis in childhood

    Energy Technology Data Exchange (ETDEWEB)

    Jamieson, D.H. [Dept. of Radiology, Red Cross War Memorial Children`s Hospital, Rondebosch (South Africa)

    1995-05-01

    A morphologically based imaging review of intracranial tuberculosis in childhood is presented. The computed tomography and magnetic resonance features of parenchymal tuberculoma, tuberculous meningitis and meningeal/meniningocerebral tuberculoma are illustrated. Recent insight into the nature of tuberculoma necrosis and its magnetic resonance correlation is reviewed. Pathogenesis, relevant clinical background and the role of modern imaging is discussed. (orig.)

  3. Resistive NMR of intracranial hematomas

    Energy Technology Data Exchange (ETDEWEB)

    Zimmerman, R.A.; Bilaniuk, L.T.; Grossman, R.I.; Levine, R.S.; Lynch, R.; Goldberg, H.I.; Samuel, L.; Edelstein, W.; Bottomley, P.; Redington, R.W.

    1985-01-01

    Comparison between computed tomography and nuclear magnetic resonance imaging in 17 patients with intracranial hematomas indicate a distinct role for NMR in evaluating the stable patient with hematoma. NMR is useful for delineating the extent of the hematoma, the relationship of the hematoma to brain anatomy, and the presence of hematoma at a time when the hematoma is isodense on CT.

  4. Idiopathic intracranial hypertension in children: Diagnostic and management approach.

    Science.gov (United States)

    Albakr, Abdulrahman; Hamad, Muddathir H; Alwadei, Ali H; Bashiri, Fahad A; Hassan, Hamdy H; Idris, Hiyam; Hassan, Saeed; Muayqil, Taim; Altweijri, Ikhlass; Salih, Mustafa A

    2016-01-01

    Idiopathic intracranial hypertension (IIH) is a rare neurological disorder in children. It is characterized by raised intracranial pressure (ICP) in the absence of brain parenchymal lesion, vascular malformations, hydrocephalus, or central nervous system (CNS) infection. The diagnosis is usually confirmed by high opening pressure of cerebrospinal fluid (CSF) with exclusion of secondary causes of intracranial hypertension. If not treated properly, it may lead to severe visual dysfunction. Here we review the etiology, clinical presentation, diagnostic criteria and management of IIH in children through illustration of the clinical and radiological presentation of a 13-year-old overweight girl who presented with severe headache, diplopia and bilateral papilledema. Otherwise, she had unremarkable neurological and systemic examinations. Lumbar puncture showed a high CSF opening pressure (360-540 mmH2O). Her investigations showed normal complete blood count (CBC), normal renal, liver, and thyroid function tests. Cerebrospinal fluid (CSF) and blood chemistry were unremarkable. Magnetic resonant image (MRI) of the brain demonstrated empty sella turcica, tortuous optic nerves, and flattening of the posterior sclera. Magnetic resonant venography (MRV) showed focal narrowing of the distal transverse sinuses and absence of venous sinus thrombosis. She required treatment with acetazolamide and prednisolone. With medical treatment, weight reduction, and exercise, our patient had a remarkable improvement in her symptoms with resolution of papilledema in two months. This review highlights the importance of early recognition and management of IIH to prevent permanent visual loss.

  5. 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.

  6. 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...... strategies, resulting in practice variation. The aim of this study was to examine variation in monitoring and treatment policies for intracranial hypertension in patients with TBI. METHODS: A 29-item survey on ICP monitoring and treatment was developed on the basis of literature and expert opinion...... the others were considered more conservative (n = 34, 52%). CONCLUSIONS: Substantial variation was found regarding monitoring and treatment policies in patients with TBI and intracranial hypertension. The results of this survey indicate a lack of consensus between European neurotrauma centers and provide...

  7. 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.

  8. 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

  9. 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).

  10. 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)

  11. 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

  12. 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.

  13. Endoscopic third ventriculostomy in idiopathic normal pressure ...

    African Journals Online (AJOL)

    Mohammed Ahmed Eshra

    2013-12-22

    Dec 22, 2013 ... with normal cerebrospinal fluid (CSF) opening pressure on lumbar puncture.1. This syndrome is characterized by mild intracranial hyper- tension due to increased CSF accumulation in the ventricular system of the brain causing ventricular enlargement. This is followed by gradual falling of the intracranial ...

  14. 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 idiopath...

  15. 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)

  16. Total intravenous anesthesia: advantages for intracranial surgery.

    Science.gov (United States)

    Cole, Chad D; Gottfried, Oren N; Gupta, Dhanesh K; Couldwell, William T

    2007-11-01

    Although volatile anesthetics have been widely accepted in anesthetic management for neurosurgery, they reduce vascular resistance, resulting in increased cerebral blood flow and increased intracranial pressure (ICP). In patients with elevated ICP who undergo craniotomy, the increase in ICP during surgery from inhaled anesthetics can make the surgery more difficult, thereby increasing the risk of ischemic cerebral insults. Total intravenous anesthesia (TIVA) using propofol and analgesic drugs (remifentanil or fentanyl) and excluding simultaneous administration of any inhaled drugs is being used in patients undergoing craniotomy because of its potential to reduce ICP and ease access to the operative site. We reviewed the literature and describe our experience with TIVA, with emphasis on hemodynamic stability, effects on ICP, emergence from anesthesia, extubation times, and return of cognitive function in patients undergoing craniotomy for space-occupying lesions. TIVA with propofol is similar to inhaled anesthetics with regard to hemodynamic stability, emergence times, extubation times, early cognitive function, and adverse events. In several prospective, randomized clinical trials, evidence suggests that ICP is decreased and cerebral perfusion pressure is increased in patients receiving TIVA when compared with those receiving volatile anesthetics during elective craniotomy procedures. The impact of TIVA on ICP, brain swelling, and access to the operative site in patients with severely elevated ICP has yet to be evaluated and is the subject of a future study at our institution.

  17. 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.

  18. 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)

  19. 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

  20. Migraine before rupture of intracranial aneurysms

    DEFF Research Database (Denmark)

    Lebedeva, Elena R; Gurary, Natalia M; Sakovich, Vladimir P

    2013-01-01

    Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA.......Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA....

  1. Phase contrast MRI in intracranial aneurysms

    NARCIS (Netherlands)

    van Ooij, P.

    2012-01-01

    Intracranial aneurysms are outpouchings of intracranial arteries that cause brain hemorrhage after rupture. Unruptured aneurysms can be treated but the risk of treatment may outweigh the risk of rupture. Local intra-aneurysmal hemodynamics can contribute substantially to the rupture risk estimation

  2. Computerised tomographic detection of intracranial complications of ...

    African Journals Online (AJOL)

    These include cerebral, subdural and epidural abscesses, frontal bone osteomyelitis. The maxillary and ethmoidal sinuses were mostly involved and can be implicated as the sinogenic causes of intracranial infections. Sphenoidal sinus was not involved in any of the patients. Key Words: Intracranial Complications, Sinusitis, ...

  3. 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.)

  4. 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

  5. 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.

  6. Endovascular treatment of intracranial aneurysm

    International Nuclear Information System (INIS)

    Wang Zhigang; Li Guoxin; Qu Yuanming; Tang Jun; Liu Zuoqin

    2001-01-01

    Objective: To setup an endovascular treatment of intracranial aneurysm with detachable balloon and micro-coil. Methods: Trans-femoral artery Seldinger's catheterization was used. Balloons and free MDS, GDC micro-coils were pushed into the aneurysm or carrying arteries. Results: No mortality occurred in authors' group. Internal carotid arteries (ICA) were occluded with detachable balloons in 5 aneurysms at sinus segment of ICA and 4 traumatic pseudo-aneurysms. No complications occurred. 9 aneurysms were completely occluded with micro-coils and 2 were partly (95%) occluded. 2 patients got mild paralysis due to vasospasm or mal detaching of MDS coils. Conclusions: Balloon occlusion of ICA for treatment of aneurysm at sinus segment is safe and effective in case of having abundant collateral circulation. Coil occlusion of intracranial aneurysm is a promising method of endovascular treatment. Compared with MDS, GDC coil is safer but expensive. Free coil is not very safe theoretically, but can be used with careful consideration as it is much cheaper

  7. 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)

  8. 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.

  9. 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)

  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. 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.

  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. 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

  16. Intracranial EEG Connectivity Analysis and Result Imaging

    Czech Academy of Sciences Publication Activity Database

    Klimeš, Petr; Janeček, Jiří; Jurák, Pavel; Halámek, Josef; Chládek, Jan; Brázdil, M.

    2012-01-01

    Roč. 2, č. 4 (2012), s. 275-279 ISSN 2010-3638 Institutional support: RVO:68081731 Keywords : Connectivity * Correlation * Intracranial EEG * Signal Processing Subject RIV: JA - Electronics ; Optoelectronics, Electrical Engineering

  17. 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

  18. The commonly missed diagnosis of intracranial hypotension

    Directory of Open Access Journals (Sweden)

    Ashlee N. Ruggeri-McKinley, BSN, RN

    2016-06-01

    Full Text Available We report a 28 year old female who presented with a subacute onset of a severe throbbing and stabbing headache after a morning spin class 9 months ago. We confirmed the diagnosis of spontaneous intracranial hypotension cause by a cerebrospinal fluid leak. The headache finally resolved after a 55 ml blood patch. Affecting an estimated 5/100,000 patients, spontaneous intracranial hypotension is considered rare in medical literature. Many patients with spontaneous intracranial hypotension are incapacitated for years and even decades. The misdiagnosis of intracranial hypotension can have serious consequences and lead to unnecessary testing and treatment. Healthcare professionals need to be aware of this diagnosis when evaluating a patient with acute head pain. Considering that physical exams are usually normal, clinicians must focus on the patient history and physical. Clues in the patient interviewing process can lead to an immediate and accurate diagnosis.

  19. 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)

  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. Mucocele and pyocele with marked intracranial extension

    Energy Technology Data Exchange (ETDEWEB)

    Tsuchiya, Kazuhiro; Machida, Tohru; Iio, Masahiro

    1984-08-01

    Two cases are presented with frontal sinus pyocele and fronto-ethmoid sinus mucocele in which marked intracranial extension is shown. Their intracranial part appeared as a large biconvex mass, which showed iso or slightly low density homogeneously and had gross calcification in the posterior rim. The findings of the paranasal sinuses and the orbit in tomograms and CT scans are thought to be useful in the differential diagnosis of chronic subdural hematoma.

  2. Spontaneous intracranial epidural hematoma during rivaroxaban treatment.

    Science.gov (United States)

    Ruschel, Leonardo Gilmone; Rego, Felipe Marques Monteiro do; Milano, Jerônimo Buzetti; Jung, Gustavo Simiano; Silva, Luis Fernando; Ramina, Ricardo

    2016-11-01

    According to our research, this is the first case described in the literature of spontaneous intracranial epidural hematoma secondary to the use of Xareltor. 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.

  3. 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

  4. 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

  5. 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.

  6. 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

  7. Intracranial Vasospasm without Intracranial Hemorrhage due to Acute Spontaneous Spinal Subdural Hematoma.

    Science.gov (United States)

    Oh, Jung-Hwan; Jwa, Seung-Joo; Yang, Tae Ki; Lee, Chang Sub; Oh, Kyungmi; Kang, Ji-Hoon

    2015-12-01

    Spontaneous spinal subdural hematoma (SDH) is very rare. Furthermore, intracranial vasospasm (ICVS) associated with spinal hemorrhage has been very rarely reported. We present an ICVS case without intracranial hemorrhage following SDH. A 41-year-old woman was admitted to our hospital with a complaint of severe headache. Multiple intracranial vasospasms were noted on a brain CT angiogram and transfemoral cerebral angiography. However, intracranial hemorrhage was not revealed by brain MRI or CT. On day 3 after admission, weakness of both legs and urinary incontinence developed. Spine MRI showed C7~T6 spinal cord compression due to hyperacute stage of SDH. After hematoma evacuation, her symptoms gradually improved. We suggest that spinal cord evaluation should be considered in patients with headache who have ICVS, although intracranial hemorrhage would not be visible in brain images.

  8. 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.)

  9. 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

  10. Use of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension.

    Science.gov (United States)

    Qureshi, A I; Suarez, J I

    2000-09-01

    To review the literature on the use of hypertonic saline (HS) in treating cerebral edema and intracranial hypertension. Review of scientific and clinical literature retrieved from a computerized MEDLINE search from January 1965 through November 1999. Pertinent literature is referenced, including clinical and laboratory investigations, to demonstrate principles and efficacy of treatment with HS in patients with intracranial space-occupying pathology. The literature was reviewed to summarize the mechanisms of action, efficacy, adverse effects, systemic effects, and comparisons with standard treatments in both clinical and laboratory settings. HS has an osmotic effect on the brain because of its high tonicity and ability to effectively remain outside the bloodbrain barrier. Numerous animal studies have suggested that fluid resuscitation with HS bolus after hemorrhagic shock prevents the intracranial pressure (ICP) increase that follows resuscitation with standard fluids. There may be a minimal benefit in restoring cerebral blood flow, which is thought to be mitigated through local effects of HS on cerebral microvasculature. In animal models with cerebral injury, the maximum benefit is observed in animals with focal injury associated with vasogenic edema (cryogenic injury). The ICP reduction is seen for efficacy in reducing ICP, but there is a suggestion that mannitol may have a longer duration of action. Human studies published to date reporting on the use of HS in treating cerebral edema and elevated ICP include case reports, case series, and small controlled trials. Results from studies directly comparing HS with standard treatment in regard to safety and efficacy are inconclusive. However, the low frequency of side effects and a definite reduction of ICP observed with use of HS in these studies are very promising. Systemic effects include transient volume expansion, natriuresis, hemodilution, immunomodulation, and improved pulmonary gas exchange. Adverse effects

  11. Inflammatory gene expression signatures in idiopathic intracranial hypertension: possible implications in microgravity-induced ICP elevation.

    Science.gov (United States)

    Zanello, Susana B; Tadigotla, Vasisht; Hurley, James; Skog, Johan; Stevens, Brian; Calvillo, Eusebia; Bershad, Eric

    2018-01-01

    The visual impairment and intracranial pressure (VIIP) syndrome is a neuro-ophthalmologic condition described in astronauts returning from long duration space missions. Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is characterized by a chronic elevation of intracranial pressure (ICP) in the absence of an intracranial mass lesion. Because VIIP and IIH share some neurologic and ophthalmologic manifestations, the latter might be used as a model to study some of the processes underlying VIIP. This work constitutes a preliminary investigation of the molecular pathways associated with the elevation of ICP in IIH. Gene expression signatures were obtained from exosomes collected from CSF and plasma in patients with possible signs of IIH. The gene expression targets focused on inflammatory genes and miRNAs. The results suggest that inflammatory cytokine-driven processes and immune cell migration are activated when ICP is elevated in IIH patients, either as a cause or effect of the ICP increase. Several miRNAs appear to be involved in this response, among which miR-9 and miR-16 are upregulated in CSF and plasma of higher ICP subjects. This study provides evidence in support of neurophysiological alterations and neuro-immunomodulation in this condition. If similar changes are seen in astronauts manifesting with the VIIP syndrome, an underlying pathophysiological basis may be discovered.

  12. Differences in Morphologic and Hemodynamic Characteristics for "PHASES-Based" Intracranial Aneurysm Locations.

    Science.gov (United States)

    Varble, N; Rajabzadeh-Oghaz, H; Wang, J; Siddiqui, A; Meng, H; Mowla, A

    2017-11-01

    Several recent prospective studies have found that unruptured intracranial aneurysms at various anatomic locations have different propensities for future rupture. This study aims to uncover the lack of understanding regarding rupture-prone characteristics, such as morphology and hemodynamic factors, associated with different intracranial aneurysm location. We investigated the characteristics of 311 unruptured aneurysms at our center. Based on the PHASES study, we separated and compared morphologic and hemodynamic characteristics among 3 aneurysm location groups: 1) internal carotid artery; 2) middle cerebral artery; and 3) anterior communicating, posterior communicating, and posterior circulation arteries. A mixed model statistical analysis showed that size ratio, low wall shear stress area, and pressure loss coefficient were different between the intracranial aneurysm location groups. In addition, a pair-wise comparison showed that ICA aneurysms had lower size ratios, lower wall shear stress areas, and lower pressure loss coefficients compared with MCA aneurysms and compared with the group of anterior communicating, posterior communicating, and posterior circulation aneurysms. There were no statistical differences between MCA aneurysms and the group of anterior communicating, posterior communicating, and posterior circulation aneurysms for morphologic or hemodynamic characteristics. ICA aneurysms may be subjected to less rupture-prone morphologic and hemodynamic characteristics compared with other locations, which could explain the decreased rupture propensity of intracranial aneurysms at this location. © 2017 by American Journal of Neuroradiology.

  13. 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.

  14. The radiological appearance of intracranial aneurysms in adults ...

    African Journals Online (AJOL)

    2014-04-04

    %. Limited literature is available on intracranial aneurysms in HIV-infected patients. Objectives: To describe the radiological appearance of intracranial aneurysms in HIV- positive adults. Method: In this retrospective analysis of ...

  15. 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...

  16. Intracranial arachnoid cysts treated surgically

    International Nuclear Information System (INIS)

    Okamoto, Junji; Matsumoto, Keizo

    1982-01-01

    Craniotomy and an examination of the maximal extent of extirpation of the cystic membrane were performed under an operative microscope in a series of 30 consecutive cases of intracranial arachnoid cysts. From these clinical features and a histological examination of the membrane, the etiologies of the arachnoid cysts may be divided into three fundamental categories: arachnoid cysts due to local brain atrophy or malformation (Category I), arachnoid cysts due to a malformation of the local arachnoid membrane itself (Category II), and arachnoid cysts due to acquired etiology (Category III). The postoperative reduction rates were investigated by means of a serial CT examination over a follow-up period of from 1 month to 6.5 years (average 2 years) in 27 cases. The postoperative reduction rates of 5 cases were less than 20% (Group A), 15 cases had rates from 30 to 80% (Group B), and 7 cases had rates of more than 90% (Group C). Cases of females, large cysts, round-shaped cysts, and cases with positive mass signs and poorly communicating cysts are revealed by metrizamide CT examination seemed to have a tendency for cystic cavity to be reduced well, judging from the postoperative analysis of the clinical findings. Furthermore, from the standpoint of our hypothesis concerning the etiology of the arachnoid cysts, Group A fit in almost all cases in Category I, though a few cases of Group A who had severe secondary local brain damage were in Category II. Group C fit in Category III in almost all cases, though a few cases of Group C who had minimal local brain damage were in Category II. Cases of Group B were considered to show some changes in the local cerebrum of various degrees in the cases of Categories II and III. (J.P.N.)

  17. Audio-Vestibular Findings in Increased Intracranial Hypertension Syndrome.

    Science.gov (United States)

    Çoban, Kübra; Aydın, Erdinç; Özlüoğlu, Levent Naci

    2017-04-01

    Idiopathic intracranial hypertension (IIH) can be manifested by audiological and vestibular complaints. The aim of the present study is to determine the audio-vestibular pathologies and their pathophysiologies in this syndrome by performing current audio-vestibular tests. The study was performed prospectively on 40 individuals (20 IIH patients, 20 healthy volunteers). Pure tone audiometry, tympanometry, vestibular evoked myogenic potentials, and electronystagmography tests were performed in both groups and the results were compared. The mean age of both groups was found to be 30.2±18.7. There were 11 females and 9 males in each group. The study group patients had significantly worse hearing levels. Pure tone averages were significantly higher in both ears of the study group (pvestibular systems are frequently affected in this condition. Our test results suggest inner ear pathologies in these patients. Higher incidence of inferior vestibular nerve and/or saccule dysfunction is detected as a novelty. Increased intracranial pressure may affect the inner ear with similar mechanisms as in hydrops.

  18. 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

  19. Intracranial sewing needles in an adult patient.

    Science.gov (United States)

    Kazanci, Atilla; Ozdemir, Halil Ibrahim; Kazanci, Burak; Kazanci, Dilek Ozturk; Er, Uygur

    2012-01-01

    A 37-year-old patient is reported with intracranial sewing needles, which were located in the right frontal lobe. Both clinical and radiological findings suggested that these needles must have been introduced in infancy before the closure of anterior fontanelle during an unsuccessful homicide. Usually intracranial foreign objects are placed due to penetrating trauma or surgical procedures. Child abuse has been known for centuries. Many types of physical traumas have been reported, especially in Western countries. In Iran, insertion of sewing needles into the brain aiming to kill the infant have been seen in a lot of cases. This situation takes part in a lot of Persian stories. We reported a 37-year-old man who had 2 intracranial sewing needles with unknown etiology.

  20. Endovascular treatment for intracranial venous sinus thrombosis

    International Nuclear Information System (INIS)

    Zhang Qiang; Li Shenmao; Ji Xunming; Miao Zhongrong; Zhu Fengshui; Zhi Xinglong; Ling Feng

    2007-01-01

    Objective: To evaluate the efficacy and risk of endovascular treatment for intracranial venous sinus thrombosis. Methods: Twenty seven patients with intracranial venous sinus thrombosis confirmed by CT, MRI, MRV and/or DSA, from 2004 September to 2006 September, were treated with anticoagulant therapy but without response and then followed by multiple modalities including endovascular treatment. Nineteen of them accepted intravenous thrombolysis and mechanical thrombus maceration, another 5 accepted intravenous thrombolysis, mechanical thrombus maceration and intraarterial thrombolysis and the last 3 with stenting. Results: After thrombolysis, symptoms and signs of 23 patients improved obviously and headache disappeared in 18 of them, but with only mild degree in other 5 and no improvement in 3. Twenty one patients among them achieved recanalization of sinuses completely as confirmed on postprocedural angiography, MRI and MRV studies taken prior to hospital discharge and other 3 achieved recanalization of sinuses partly. Conclusion: Endovascular treatment is an effective and safe measure for potentially catastrophic intracranial dural sinus thrombosis. (authors)

  1. Computed tomographic findings of spontaneous intracranial hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Seung Sook; Kim, Young Sook; Kim, Young Chul [College of Medicine, Chosun University, Kwangju (Korea, Republic of)

    1987-10-15

    Computed tomography (CT) was a reliable technique to evaluate the exact size and location of spontaneous intracranial hemorrhage and to predict it's prognosis. Fifty-nine cases of spontaneous intracranial hemorrhage were evaluated and reviewed by CT scan. The following results were obtained. 1. The sex ratio of male to female was 1 to 1.4, The highest incidence was in 6th and 7th decades. 2. The most common cause of spontaneous intracranial hemorrhage was hypertension (74.6%), followed by the aneurysm (13.5%), arteriovenous malformation (5.1%), occlusive vascular disease (3.4%), and blood dyscrasia (3.4%). 3. The most common location was basal ganglia and thalamic hemorrhage (37.3%), followed by lobar hemorrhage (27.1%), cerebellar hemorrhage (13.5%), and subarachnoid hemorrhage (11.9%). 4. Primary intraventricular hemorrhage carried the highest mortality. 5. The larger volume of hematoma, the higher the mortality rate.

  2. 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.

  3. 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 ...

  4. Nephrogenic Diabetes Insipidus with Intracranial Calcifications in a ...

    African Journals Online (AJOL)

    Introduction: There are numerous causes for intracranial calcification in children. We describe an unusual cause of intracranial calcifications in a child, namely, nephrogenic diabetes insipidus (NDI). Case Report: A 12-year-old boy presented with seizures and developmental delay. MRI of the brain revealed intracranial ...

  5. 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.

  6. 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.

  7. 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.

  8. 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)

  9. [Cranial subdural hematoma with intracranial hypotension related to epidural anesthesia and Trendelenburg position: a case report].

    Science.gov (United States)

    Narisawa, Ayuka; Oda, Shinya; Iizawa, Kazue; Yokoo, Noriko; Nakane, Masaki; Kawamae, Kaneyuki

    2011-08-01

    We report a case of cranial subdural hematoma with intracranial hypotension. A 34-year-old woman had laparoscopic ovarial cysterectomy under general anesthesia combined with epidural anesthesia. Two days later, she developed a severe headache and nausea. She underwent cranial magnetic resonance imaging (MRI) scanning, and was diagnosed with cranial subdural hematoma with intracranial hypotension. The patient had had no anticoagulant therapy before the surgery. She was managed conservatively with bed rest and additional intravenous infusion. Her symptoms gradually improved except a slight headache, and she was discharged on the 38th postoperative day. Intracranial hypotension is a syndrome characterized by orthostatic headaches and hypovolemia of cerebrospinal fluid (CSF). There were typical findings on MRI, which include linear enhancement of the pachymeninges, pituitary hyperemia and subdural hemorrhage. We thought that these were due to epidural anesthesia first, but there was no evidence of dural puncture. It was also considered that it is influenced by change in CSF pressure, and intracranial venous engorgement may be due to Trendelenburg position for several hours. Because cranial subdural hematoma is a life-threatening complication, it is necessary to reconsider application of epidural anesthesia for laparoscopic surgery with Trendelenburg position.

  10. A Non-Invasive Biomarker for Intracranial Pressure

    Science.gov (United States)

    2011-04-01

    These  results  were  robust,  good   for  three  different  rats  across  nine   different   cycles  of  ICP...engineer,  engaged  to  refine  experimental  equipment.   Trevor  Dickey.     Biochemist  and  Engineer,  engaged  to  run

  11. Model-Based, Noninvasive Monitoring of Intracranial Pressure

    Science.gov (United States)

    2013-07-01

    segment of recorded data with some sporadic episodes of noise and artifact (right panel). The data we collected was turned over to the PhysioNet team...for merging with the rest of the MIMIC II database and release to the interested research community through the PhysioNet website (http://physionet.org...under this project augment the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC II) database and have been released to PhysioNet (http

  12. Management of Raised Intracranial Pressure in Head Injury

    African Journals Online (AJOL)

    College of Mediceine. University of Malawi .... The head-end of the bed is raised to about 30 degrees, taking care not to kink the ... Clinical Benefits. The beneficial effect of hyperventilation is almost immediate and most marked in the ac~lte stage of head injury. As a rule, there is noticeable reduction in ICP with- in about 10 ...

  13. 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.

  14. Role of intracranial cavities in avian directional hearing

    DEFF Research Database (Denmark)

    Larsen, Ole Næsbye; Christensen-Dalsgaard, Jakob; Jensen, Kenneth Kragh

    2016-01-01

    Whereas it is clear from anatomical studies that all birds have complex interaural canals connecting their middle ears, the effect of interaural coupling on directional hearing has been disputed. A reason for conflicting results in earlier studies may have been that the function of the tympanic ear...... and hence of the interaural coupling is sensitive to variations in the intracranial air pressure. In awake birds, the middle ears and connected cavities are vented actively through the pharyngotympanic tube. This venting reflex seems to be suppressed in anesthetized birds, leading to increasingly lower...... been reported. The anatomical basis of this coupling is the 'interaural canal,' which turns out to be a highly complex canal and cavity system, which we describe for the zebra finch. Surprisingly, given the complexity of the interaural canals, simple models of pipe-coupled middle ears fit the eardrum...

  15. Demographic profile of patients diagnosed with intracranial ...

    African Journals Online (AJOL)

    Background: Meningiomas are common brain tumours and display gender, racial and ethnic differences in their demographic profile. The demographic profile of our patients diagnosed with intracranial meningiomas is presented and compared with the literature. Objectives: To determine the age, gender, racial and ethnic ...

  16. CT and MRI of ruptured intracranial dermoids

    Energy Technology Data Exchange (ETDEWEB)

    Wilms, G.; Demaerel, P.; Baert, A.L. (Leuven Univ. Hospital (Belgium). Dept. of Radiology); Casselman, J. (Akademisch Ziekenhuis St. Jan, Brugge (Belgium). Dept. of Radiology); Plets, C. (Leuven Univ. Hospital (Belgium). Dept. of Neurosurgery); Haene, I. de (Akademisch Ziekenhuis St. Jan, Brugge (Belgium). Dept. of Neurology)

    1991-04-01

    Two patients with ruptured intracranial dermoids, examined with both CT and MRI are reported. Clinical presentation was transient cerebral ischemia in one patient and acute meningeal signs in the other. CT scan showed typical fat density of the tumor and the subarachnoid space. On MRI both the tumor and the subarachnoid fat, were strongly hyperintense on T1-weighted images. (orig.).

  17. 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.

  18. CONTEMPORARY ENDOVASCULAR TREATMENT OF INTRACRANIAL ANEURYSMS

    Directory of Open Access Journals (Sweden)

    Dragan Stojanov

    2015-06-01

    Full Text Available In the past twenty years we have witnessed a revolution in the treatment of intracranial aneurysms. Endovascular technique and materials have rapidly developed since the approval of Guglielmi detachable coils in 1995 which now allow successful treatment of most aneurysms. The development of intracranial stents and balloons for stent-assisted coiling and balloon-remodeling technique further expanded the spectrum of aneurysms treatable with endovascular technique. For these reasons, the aim of this review was to describe endovascular technique and materials which we use in our daily practice, to show benefits of endovascular treatment and to discus complications of endovascular treatment and surgical treatment of intracranial aneurysms. Endovascular treatment is more comfortable for the patient not only because it is minimally invasive but also because it does not require long hospitalization equal to that after surgical treatment. It is a fact that with further development of endovascular materials, this a procedure will have even a more significant place in the treatment of intracranial aneurysms.

  19. Calcification of intracranial vessels in neurocysticercosis

    Energy Technology Data Exchange (ETDEWEB)

    Fernandez-Bouzas, A. [ENEP Iztacala, Universidad Nacional Autonoma de Mexico, Mexico (Mexico); Ballesteros-Maresma, A. [Radiologia Clinica de Cuernavaca (Mexico); Casian, G.; Hernandez-Martinez, P. [Hospital Juarez de Mexico S. S. (Mexico); Martinez-Lopez, M. [Fundacion Clinica Medica Sur (Mexico)

    2000-07-01

    We report calcification of intracranial vessels in neurocysticercosis. Calcification was observed in the middle cerebral arteries in two patients, and the circle of Willis in two others. The patients with middle cerebral artery calcification underwent CT with inhaled stable xenon and an area of mild hypoperfusion was observed in the ipsilateral cerebral hemisphere. (orig.)

  20. Intracranial neoplasmin Ibadan, Nigeria | Olasode | East African ...

    African Journals Online (AJOL)

    Objective: To determine the pattern of histopathological variants of intracranial neoplasms, relative distribution of the variants in the age groups and also to determine the gender differences that exist in these tumours. Design: Case control study. Setting: Department of Pathology, University College Hospital, Ibadan, Nigeria.

  1. MR diffusion imaging of human intracranial tumours

    DEFF Research Database (Denmark)

    Krabbe, K; Gideon, P; Wagn, P

    1997-01-01

    We used MRI for in vivo measurement of brain water self-diffusion in patients with intracranial tumours. The study included 28 patients (12 with high-grade and 3 with low-grade gliomas, 7 with metastases, 5 with meningiomas and 1 with a cerebral abscess). Apparent diffusion coefficients (ADC) wer...

  2. Intracranial hypertension following neck dissection

    NARCIS (Netherlands)

    de Vries, W. A.; Balm, A. J.; Tiwari, R. M.

    1986-01-01

    A 51-year-old man developed prolonged papilloedema as a result of increased cerebrospinal fluid pressure following staged bilateral radical neck dissection. The patient recovered completely with no further specific therapy. Although the prognosis for vision is usually good in patients with

  3. 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

  4. 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

  5. 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

  6. ICP Monitoring and Phase-Contrast MRI to Investigate Intracranial Compliance.

    Science.gov (United States)

    Lokossou, A; Balédent, O; Garnotel, S; Page, G; Balardy, L; Czosnyka, Z; Payoux, P; Schmidt, E A

    2018-01-01

    The amplitude of intracranial pressure (ICP) can be measured by ICP monitoring. Phase-contrast magnetic resonance imaging (PCMRI) can quantify blood and cerebrospinal fluid (CSF) flows. The aim of this work was to investigate intracranial compliance at rest by combining baseline ICP monitoring and PCMRI in hydrocephalus patients. ICP monitoring was performed before infusion testing to quantify ΔICP_rest at the basal condition in 33 suspected hydrocephalus patients (74 years). The day before, patients had had a PCMRI to assess total cerebral blood flow (tCBF), intracranial blood volume change (stroke volume SVblood), and cervical CSF volume change (the stroke volume CSV). Global (blood and CSF) intracranial volume change (ΔIVC) during each cardiac cycle (CC) was calculated. Finally, Compliance: C_rest = ΔIVC/ΔICP_rest was calculated. The data set was postprocessed by two operators according to blind analysis. Bland-Altman plots showed that measurements presented no significant difference between the two operators. ΔICP_rest = 2.41 ± 1.21 mmHg, tCBF = 469.89 ± 127.54 mL/min, SVblood = 0.82 ± 0.32 mL/cc, CSV = 0.50 ± 0.22 mL/cc, ΔIVC = 0.44 ± 0.22 mL, and C_rest = 0.23 ± 0.15 mL/mmHg. There are significant relations between SVblood and CSV and also SVblood and tCBF. During "basal" condition, the compliance amplitude of the intracranial compartment is heterogeneous in suspected hydrocephalus patients, and its value is lower than expected! This new parameter could represent new information, complementary to conventional infusion tests. We hope that this information can be applied to improve the selection of patients for shunt surgery.

  7. 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)

  8. 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.)

  9. The evaluation of cerebral hemodynamics in patients with intracranial tumors by stable xenon CT

    International Nuclear Information System (INIS)

    Shimoda, Masami; Kawamata, Fumio; Yamamoto, Masahiro; Ohsuga, Hitoshi; Hidaka, Mitsuru; Oda, Shinri; Shibuya, Naoki; Yamamoto, Isao; Sato, Osamu

    1989-01-01

    In evaluating cerebral regional blood flow (rCBF), stable xenon-enhanced tomography (XeCT) study associated with simultaneous blood sampling was applied in 15 cases of intracranial neoplasms. The effect of intravenous glycerol infusion on rCBF was also investigated. The results indicated that intratumoral rCBF values were not only variable and unrelated to their histological types and grades, but also were not correlated with the vascularity of the lesion as demonstrated by angiography. When a tumor mass was enhanced after the injection of iodinated contrast media, it proved to be useful in distinguishing tumor mass and its associated edema that the rCBF of the peritumoral edematous region was predominantly low (10±5 ml/100 g/min). The regional cerebral blood flow in remote areas, both ipsilateral and contralateral to the lesion, was low in value, and there was no statistical significance between affected and sound sides. Following glycerol administration, rCBF was increased in the whole intracranial region, but not inside of the neoplasm, particularly when the intracranial pressure (ICP) was increased. It was assumed that the elevated rCBF after glycerol administration was due to the increase in the cerebral perfusion pressure resulting from the ICP reduction, the hemodilution effect, cerebral vessel dilatation after metabolic acidosis, and/or mechanically rectified microcirculation after edema reduction. (author)

  10. MR diffusion imaging of human intracranial tumours

    DEFF Research Database (Denmark)

    Krabbe, K; Gideon, P; Wagn, P

    1997-01-01

    We used MRI for in vivo measurement of brain water self-diffusion in patients with intracranial tumours. The study included 28 patients (12 with high-grade and 3 with low-grade gliomas, 7 with metastases, 5 with meningiomas and 1 with a cerebral abscess). Apparent diffusion coefficients (ADC) were...... (P meningiomas did not differ significantly from those seen with high-grade gliomas or cerebral metastases...

  11. 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.

  12. Intracranial Volume Quantification from 3D Photography

    OpenAIRE

    Tu, Liyun; Porras, Antonio R.; Ensel, Scott; Tsering, Deki; Paniagua, Beatriz; Enquobahrie, Andinet; Oh, Albert; Keating, Robert; Rogers, Gary F.; Linguraru, Marius George

    2017-01-01

    3D photography offers non-invasive, radiation-free, and anesthetic-free evaluation of craniofacial morphology. However, intracranial volume (ICV) quantification is not possible with current non-invasive imaging systems in order to evaluate brain development in children with cranial pathology. The aim of this study is to develop an automated, radiation-free framework to estimate ICV. Pairs of computed tomography (CT) images and 3D photographs were aligned using registration. We used the real I...

  13. 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)

  14. 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.)

  15. 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.

  16. Magnetic resonance imaging of intracranial hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Smith, H.J. (Rikshospitalet, Oslo (Norway))

    1989-04-01

    The signal intensity of a hematoma at Magnetic Resonance Imaging (MRI) is largely determined by the presence of paramagnetic substances derived from hemoglobin. Depending upon their structure and molecular mobility, paramagnetic substances may shorten the T1 and T2 of surrounding water protons and thus alter the MRI signal intensity and contrast. The article describes the evolution of intracranial hematomas and explains the relationship between the paramagnetic substance present and the result signal intensity at 1.5 T.

  17. Frontal mucocele with intracranial extension causing frontal lobe syndrome.

    Science.gov (United States)

    Weidmayer, Sara

    2015-06-01

    Mucoceles are mucus-containing cysts that form in paranasal sinuses; although mucoceles themselves are benign, this case report highlights the extensive damage they can cause as their expansion may lead to bony erosion and extension of the mucocele into the orbit and cranium; it also presents a rarely reported instance of frontal sinus mucocele leading to frontal lobe syndrome. A thorough discussion and review of mucoceles is included. A 68-year-old white man presented with intermittent diplopia and a pressure sensation in the right eye. He had a history of chronic sinusitis and had had endoscopic sinus surgery 5 years prior. A maxillofacial computed tomography scan revealed a large right frontal sinus mucocele, which had caused erosion along the medial wall of the right orbit and the outer and inner tables of the right frontal sinus. The mucocele had protruded both into the right orbit and intracranially, causing mass effect on the frontal lobe, which led to frontal lobe syndrome. The patient was successfully treated with endoscopic right ethmoidectomy, radial frontal sinusotomy, marsupialization of the mucocele, and transcutaneous irrigation. Paranasal sinus mucoceles may expand and lead to bony erosion and can become very invasive in surrounding structures such as the orbit and cranium. This case not only exhibits a very rare presentation of frontal sinus mucocele with intracranial extension and frontal lobe mass effect causing a frontal lobe syndrome but also demonstrates many of the ocular and visual complications commonly associated with paranasal sinus mucoceles. Early identification and surgical intervention is vital for preventing and reducing morbidity associated with invasive mucoceles, and the patient must be followed regularly to monitor for recurrence.

  18. Delayed Onset Intracranial Subdural Hematoma Following Spinal Surgery.

    Science.gov (United States)

    Işik, Semra; Yilmaz, Baran; Ekşi, Murat Şakir; Özcan-Ekşi, Emel Ece; Akakin, Akin; Toktaş, Zafer Orkun; Demir, Mustafa Kemal; Konya, Deniz

    2016-06-01

    In this case-based review, the authors analyzed relevant literature with an illustrative patient of theirs about subdural hematoma secondary to dural tear at spinal surgery. Intracranial hypotension is a condition of decreased cerebrospinal fluid volume and pressure. Even though intracranial hypotension is temporary and can be managed conservatively, it may progress and result in subdural fluid collections, hematoma formations, "brain sagging or slumping" states, syringohydromyelia, encephalopathy, coma, and even death. The authors present an 81-year-old man admitted with subdural hematoma 50 days following previous spinal surgery for lumbar spinal stenosis. In his previous spinal surgery he had had dural tear, which had been closed primarily. To the literature, only 21 patients have been reported to develop subdural hematoma following spinal surgery. In patients with subdural hematoma following spinal surgery, the female:male ratio was 3:4 and the median age was 55 years. Surgical diagnoses for previous spinal surgeries were intervertebral disc herniation (5), spinal canal stenosis and spondylolisthesis (6), failed back syndrome (2), tethered cord syndrome and myelodysplastic spine (2), spinal cord tumor, spinal epidural hematoma, vertebral dislocation, vertebral fracture, vertebral tumor, and inflammatory spine. Patients presented with signs and symptoms of subdural hematoma within 6 hours to 50 days following the spinal surgery. Source of cerebrospinal fluid leak was most commonly from lumbar region (13 patients, 62%). Ten of 21 (48%) patients were treated conservatively. Late-onset neurological findings should not prevent the evaluation of cranial vault with computed tomography and magnetic resonance imaging. Spinal dural tear should be more aggressively treated instead of suture alone approach, when recognized in older patients during the spinal surgery.

  19. 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.)

  20. 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)

  1. 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.

  2. 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.)

  3. 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...... (VEGF) is an endothelial cell-specific mitogen and angiogen. VEGF-A protein, which is identical to vascular permeability factor, is a regulator of angiogenesis. In this study, 101 patients with meningiomas, and possible co-factors to PTBE, such as meningioma subtypes and tumor location, were examined....... 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...

  4. Intracranial Subdural Hematoma after Spinal Anesthesia for Cesarean Section

    OpenAIRE

    Schweiger, Vittorio; Zanconato, Giovanni; Lonati, Gisella; Baggio, Silvia; Gottin, Leonardo; Polati, Enrico

    2013-01-01

    Intracranial subdural hematoma following spinal anesthesia is an infrequent occurrence in the obstetric population. Nevertheless, it is a potentially life-threatening complication. In the majority of the cases, the first clinical symptom associated with intracranial subdural bleeding is severe headache, but the clinical course may have different presentations. In this report, we describe the case of a 38-year-old woman with an acute intracranial subdural hematoma shortly after spinal anesthe...

  5. Computerized tomographic evaluation of intracranial metastases

    International Nuclear Information System (INIS)

    Kim, Bo Yong; Lee, Mi Sook; Choi, Jin Ok; Jeon, Doo Sung; Kim, Hong Soo; Rhee, Hak Song

    1986-01-01

    In a study of intracranial metastases, 46 cases having satisfactory clinical, operative and histological proofs were analyzed by computerized tomography at Presbyterian Medical Center from May, 1982 to February, 1986. The results were as follows: 1. The male to female ratio of intracranial metastases were 67:33. The 5th decade group (34.8%) was the most prevalent age group, followed by the 6th decade (21.7%) and 7th decade (21.7%). 2. The number of lesions was found be: single -25 cases (54.3%); multiple -21 cases (45.7%). 3. The source of intracranial metastases found to be: lung 15 cases (32.6%); unknown 12 cases (26.0%); chorioca 3 cases (6.5%); liver 3 cases (6.5%); stomach 2 cases (4.3%); parotid, breast, kidney, prostate, melanoma, rectal ca, rhabdomyosarcoma, nasal ca, lymphoma, testicular ca, cervix, each 1 case (2.2%). 4. The locations of the intracranial metastases were as follows: Cerebral hemisphere 37.7% in parietal region Cerebral hemisphere 15.9% in in frontal region Cerebral hemisphere 13.4% in occipital region Cerebral hemisphere 10.5% in temporal region Cerebellar hemisphere 3.2% Cerebellopontine angle 3.2% Intraventricular 4.8% Meninges 4.8% Skull vault 6.5% 5. Peritumor edema was found to be: Grade II-17 cases (37.0%): Grade III-14 cases (30.4%); Grade I-8 cases (17.4%); Grade 0-7 cases (15.2%) in that order. 6. The chief complaints of intracranial metastases on admission, were as follows: Headache 30 cases (65.2%); Vomiting 11 cases (23.9%); deteriorated mental state 10 cases (21.7%); Hemiplegia 7 cases (15.2%); visual disturbance 6 cases (13.0%); hemiparesis 4 cases (8.7%); seizure 4 cases (8.7%); other symptoms were less frequent. 7. On pre-contrast scan, hyperdense lesions were present in 18 cases (39.1%); hypodense lesions in 15 cases (32.6%); mixed density in 8 cases (17.4%); isodensity was present in 5 cases (10.9%). On post-contrast scan, ring enhancement was seen in 19 cases (41.3%); nodular enhancement in 17 cases (37%), mixed ring

  6. Computerized tomographic evaluation of intracranial metastases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bo Yong; Lee, Mi Sook; Choi, Jin Ok; Jeon, Doo Sung; Kim, Hong Soo; Rhee, Hak Song [Presbyterian Medical Center, Chonju (Korea, Republic of)

    1986-12-15

    In a study of intracranial metastases, 46 cases having satisfactory clinical, operative and histological proofs were analyzed by computerized tomography at Presbyterian Medical Center from May, 1982 to February, 1986. The results were as follows: 1. The male to female ratio of intracranial metastases were 67:33. The 5th decade group (34.8%) was the most prevalent age group, followed by the 6th decade (21.7%) and 7th decade (21.7%). 2. The number of lesions was found be: single -25 cases (54.3%); multiple -21 cases (45.7%). 3. The source of intracranial metastases found to be: lung 15 cases (32.6%); unknown 12 cases (26.0%); chorioca 3 cases (6.5%); liver 3 cases (6.5%); stomach 2 cases (4.3%); parotid, breast, kidney, prostate, melanoma, rectal ca, rhabdomyosarcoma, nasal ca, lymphoma, testicular ca, cervix, each 1 case (2.2%). 4. The locations of the intracranial metastases were as follows: Cerebral hemisphere 37.7% in parietal region Cerebral hemisphere 15.9% in in frontal region Cerebral hemisphere 13.4% in occipital region Cerebral hemisphere 10.5% in temporal region Cerebellar hemisphere 3.2% Cerebellopontine angle 3.2% Intraventricular 4.8% Meninges 4.8% Skull vault 6.5% 5. Peritumor edema was found to be: Grade II-17 cases (37.0%): Grade III-14 cases (30.4%); Grade I-8 cases (17.4%); Grade 0-7 cases (15.2%) in that order. 6. The chief complaints of intracranial metastases on admission, were as follows: Headache 30 cases (65.2%); Vomiting 11 cases (23.9%); deteriorated mental state 10 cases (21.7%); Hemiplegia 7 cases (15.2%); visual disturbance 6 cases (13.0%); hemiparesis 4 cases (8.7%); seizure 4 cases (8.7%); other symptoms were less frequent. 7. On pre-contrast scan, hyperdense lesions were present in 18 cases (39.1%); hypodense lesions in 15 cases (32.6%); mixed density in 8 cases (17.4%); isodensity was present in 5 cases (10.9%). On post-contrast scan, ring enhancement was seen in 19 cases (41.3%); nodular enhancement in 17 cases (37%), mixed ring

  7. [Measurement of intracranial hematoma using the improved cubature formula].

    Science.gov (United States)

    Lu, Xiao; Lu, Wen

    2010-06-01

    The more accurate calculate method was investigated according to the improved formula of intracranial hematoma using segment deducing. The improved formula was deduced to calculate the intracranial hematoma using the volume formula of the solid geometry. The volume of intracranial hematoma was measured as a related accurate standards using software. The volumes of intracranial hematoma calculated by the improved formula, Tada's formula and the software were compared. The measure accuracy of the improved formula was higher than that of Tada's formula, and showed a similarity with that by using software method. The improved formula method shows a more accurate result than Tada's formula, and can be used in forensic practice.

  8. Paradoxical Increase in Mortality and Rupture of Intracranial Aneurysms in Microsomal Prostaglandin E2 Synthase Type 1-Deficient Mice: Attenuation by Aspirin.

    Science.gov (United States)

    Peña Silva, Ricardo A; Mitchell, Ian J; Kung, David K; Pewe, Lecia L; Granja, Manuel F; Harty, John T; Faraci, Frank M; Heistad, Donald D; Hasan, David M

    2015-10-01

    Inflammation plays an important role in formation and rupture of intracranial aneurysms. Expression of microsomal prostaglandin E2 (PGE2) synthase type 1 (mPGES-1) is increased in the wall of intracranial aneurysms in humans. PGE2, a by-product of mPGES-1, is associated with inflammation and cerebrovascular dysfunction. To test the hypothesis that deletion of mPGES-1 decreases the formation and rupture of intracranial aneurysms in a murine model. Intracranial aneurysms were induced in wild-type and mPGES-1 knockout (mPGES-1 KO) mice by using a combination of deoxycorticosterone acetate-salt-induced hypertension and intracranial injection of elastase in the basal cistern. Prevalence of aneurysms, subarachnoid hemorrhage, and mortality were assessed. We also tested the effects of administration of aspirin (6 mg/kg/d) by gavage and PGE2 (1 mg/kg/d) by subcutaneous infusion. Systolic blood pressure and prevalence of aneurysm were similar in wild-type and mPGES-1 KO mice. However, mortality and the prevalence of subarachnoid hemorrhage were markedly increased in mPGES-1 KO mice (P increase rupture of intracranial aneurysms. Aspirin, but not PGE2, attenuated the increased mortality in mPGES-1 KO mice (P increase in rupture of cerebral aneurysms and mortality, which are attenuated by low-dose aspirin.

  9. 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

    2018-02-23

    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.

  10. 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

  11. 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 experimenta