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Li P, Han F, Jin X, Wang Y, Zhao Y. [Diagnosis and treatment of spontaneous meningoencephalocele in lateral recess of sphenoid sinus and analysis of its influencing factors]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2024; 38:288-291;297. [PMID: 38563170 DOI: 10.13201/j.issn.2096-7993.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Indexed: 04/04/2024]
Abstract
Objective:To explore the influencing factors of adult spontaneous meningoencephalocele, which occurs in the lateral recess of sphenoid sinus, in order to improve the level of clinical diagnosis and treatment. Methods:The clinical data of 27 adults with spontaneous meningoencephalocele in lateral recess of sphenoid sinus in Department of the Otorhinolaryngology, the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2022 were retrospectively analyzed. Preoperative sinus CT and MRI were performed to confirm the diagnosis and location of meningoencephalocele. Results:①There were 0 cases of lateral recess of sphenoid sinus type Ⅰ, 8 cases of lateral recess of sphenoid sinus type Ⅱ and 19 cases of lateral recess of sphenoid sinus type Ⅲ. ②Among the 27 adult patients with spontaneous meningoencephalocele, 9 were male and 18 were female, and the onset age was 19-72 years old, with an average age of(50.7±12.4) years old. 18 cases were complicated with cerebrospinal fluid leakage, 11 cases with headache and dizziness, 3 cases with recurrent meningitis(complicated with cerebrospinal fluid leakage), and 2 cases with epilepsy. ③There were 20 patients with intracranial hypertension, 17 patients with body mass index(BMI) ≥25 kg/m², and 8 patients with empty sella. Conclusion:Type Ⅲ of lateral recess of sphenoid sinus is the most common type in adult spontaneous meningoencephalocele, and intracranial hypertension and obesity are the influencing factors of this disease. Puncture, biopsy or operation should not be performed for patients suspected of spontaneous meningoencephalocele, and imaging examination should be performed to identify the source of the tumor.
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Affiliation(s)
- Ping Li
- Department of the Otorhinolaryngology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,450052,China
| | - Feiyan Han
- Department of the Otorhinolaryngology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,450052,China
| | - Xiaolang Jin
- Department of the Otorhinolaryngology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,450052,China
| | - Ying Wang
- Department of the Otorhinolaryngology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,450052,China
| | - Yulin Zhao
- Department of the Otorhinolaryngology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,450052,China
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Feucht D, Kerscher SR, Ruff C, Schuhmann MU, Roder C, Zipfel J. Retrospective longitudinal assessment of optic nerve sheath diameter in patients with malignant glioma. Cancer Med 2023; 12:22047-22055. [PMID: 38063340 PMCID: PMC10757086 DOI: 10.1002/cam4.6789] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 09/25/2023] [Accepted: 11/23/2023] [Indexed: 12/31/2023] Open
Abstract
INTRODUCTION Glioblastoma (GBM) is a tumor with rapid growth and a possible relationship to elevated intracranial pressure (ICP). High ICP may not always be associated with clinical signs. A non-invasive technique for assessment of ICP is measuring the optic nerve sheath diameter (ONSD). Identifying patients who need immediate intervention is of importance in neuro-oncological care. The goal of this study is to assess the available magnetic resonance imaging (MRI) of patients with GBM with respect to pre- and postoperative ONSD. METHODS AND MATERIALS Retrospective data analysis was performed on all patients operated for GBM at a tertiary care center between 2010 and 2020. Two pre and one postoperative MRI had to be available. Clinical data and ONSD at multiple time points were analyzed and correlated, as well as preoperative volumetrics. RESULTS Sixty-seven patients met the inclusion criteria. Clinical signs of elevated ICP were seen in 25.4% (n = 17), while significant perifocal edema was present in 67.2% (n = 45) of patients. Clinical signs of preoperatively elevated ICP were associated with significantly elevated ONSD at diagnosis (p < 0.001) as well as preoperative tumor volume (p < 0.001). Significant perifocal edema at the time of diagnosis was associated with elevated ONSD (p = 0.029) and higher tumor volume (p = 0.003). In patients with significant edema, ONSD increased significantly between preoperative MRIs (p = 0.003/005). In patients with clinical signs of raised ICP, ONSD also increased, whereas it was stable in asymptomatic patients (yes: 5.01+/-4.17 to 5.83+/-0.55 mm, p = 0.010, no: 5.17+/-0.46 mm to 5.38+/-0.41 mm, p = 0.81). A significant increase of ONSD from diagnosis to preoperative MRI and a significant decrease until 3 months postoperatively were observed (p < 0.001). CONCLUSIONS ONSD might help identify high ICP in patients with GBM. In this first-of-its kind study, we observed a significant increase of ONSD preoperatively, likely associated with edema. Postoperatively, ONSD decreased significantly until 3 months after surgery and increased again at 12 months. Further prospective data collection is warranted.
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Affiliation(s)
- Daniel Feucht
- Department of NeurosurgeryUniversity Hospital of TuebingenTubingenGermany
| | - Susanne R. Kerscher
- Department of Diagnostic and Interventional RadiologyUniversity Hospital of UlmUlmGermany
| | - Christer Ruff
- Department of Diagnostic and Interventional NeuroradiologyUniversity Hospital of TuebingenTubingenGermany
| | | | - Constantin Roder
- Department of NeurosurgeryUniversity Hospital of TuebingenTubingenGermany
| | - Julian Zipfel
- Department of NeurosurgeryUniversity Hospital of TuebingenTubingenGermany
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Ma Z, Jiang H, Wang J. Enhancement of optic nerve sheath on MRI in idiopathic intracranial hypertension(IIH). Clin Neurol Neurosurg 2023; 231:107778. [PMID: 37348315 DOI: 10.1016/j.clineuro.2023.107778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/03/2023] [Accepted: 05/06/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE Optic nerve sheath(ONS) enhancement in idiopathic intracranial hypertension (IIH) patients has been reported in recent years. In this retrospective observation, we analyzed the clinical characteristics of IIH patients with enhancement of ONS. METHODS Eighty-two patients with clinically diagnosed IIH from January 2017 to December 2019 were under observation. Then, based on the presence of contrast-enhancement (CE) in ONS on orbital magnetic resonance image (MRI), the IIH patients were divided into CE-ONS group and no-CE(NCE)-ONS group. Six months follow-up information was also included in the observation study. By comparing clinical data of the two groups of IIH patients, we tried to evaluate whether there is clinical heterogeneity in CE-ONS patients. RESULT 12 patients were included in CE-ONS group, 10 females and 2 males. 70 patients were included in NCE-ONS group, 56 women and 14 men. We found that patients with CE-ONS had a longer course of disease (median disease duration before diagnosis, 5 months vs. 3months, P<0.01) and more likely had the sign of distension of the perioptic subarachnoid space (DPSS) (58.33 % vs. 24.29 %, P = 0.034). But no significant differences were found in demographic characteristics, clinical symptoms, degree of visual impairment, papilledema, opening pressure(OP) on lumbar puncture and clinical outcomes. CONCLUSION As a rare sign on MRI, ONS enhancement can occur in patients with IIH. IIH patients with CE-ONS may have a longer course of disease and more prone to DPSS, but there is no significant difference in clinical manifestations, OP, and clinical outcomes compared with IIH patients without CE-ONS.
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Affiliation(s)
- Zhonghua Ma
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Hanqiu Jiang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Jiawei Wang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
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Gönen AO, Kaya G, Tütüncü AÇ, Özcan R, Emre Ş, Kendigelen P. Effect of paediatric caudal injection volume on optic nerve sheath diameter and regional cerebral oximetry: A randomised trial. Eur J Anaesthesiol 2023; 40:465-471. [PMID: 36938985 DOI: 10.1097/eja.0000000000001819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Caudal injections commonly used for neuraxial anaesthesia in children can displace cerebrospinal fluid cranially causing safety concerns in terms of raised intracranial pressure. Optic nerve sheath diameter (ONSD) is a noninvasive surrogate for the measurement of intracranial pressure. Regional cerebral oximetry (CrSO 2 ) can monitor brain oxygenation, which may decrease by a reduction in cerebral flow due to increased intracranial pressure. OBJECTIVES Comparing how caudal injection volumes of 0.8 and 1.25 ml kg -1 influence ONSD and CrSO 2 within the first 30 min after injection. DESIGN Prospective, randomised and parallel group trial. SETTING Operating room. PATIENTS Fifty-eight elective paediatric surgical patients between ages 1 and 7 years old, ASA class I or II, without previous intracranial or ocular pathology and surgery appropriate for single - shot caudal anaesthesia. INTERVENTION Single-shot caudal anaesthesia with 0.8 ml kg -1 (group L, n = 29) and 1.25 ml kg -1 (group H, n = 29) of 2 mg kg -1 bupivacaine solution. MAIN OUTCOME MEASURES Optic nerve sheath diameter measured with ultrasonography and regional cerebral oximetry measured by near - infrared spectroscopy before (NIRS), immediately after, 10, 20 and 30 min after the block. RESULTS Mean ONSD values increased from a baseline of 4.4 ± 0.2 mm to a maximum of 4.5 ± 0.2 mm 20 min after injection in group L and from a baseline of 4.5 ± 0.3 mm to a maximum of 4.8 ± 0.3 mm 10 min after injection in group H. Eight of 29 patients in group H and none in group L had an ONSD increase by more than 10%. Both groups had a reduction of less than 2.5% in CrSO 2 . CONCLUSION Caudal injection with 1.25 ml kg -1 increased ONSD, an indirect measurement of ICP, more than 0.8 ml kg -1 and neither volume caused a clinically important reduction in CrSO 2 . TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04491032.
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Affiliation(s)
- Aybike Onur Gönen
- From the Department of Anaesthesiology and Intensive Care (AOG, GK, AÇT, PK) and Department of Paediatric Surgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Fatih/İstanbul, Türkiye (RÖ, SE)
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Çankaya I, Bayar Muluk N, Burulday V, Karadeniz Bilgili MY, Özdemir A. Noticable Findings in Cranial MRI of the Patients with Idiopathic Intracranial Hypertension. Am J Rhinol Allergy 2022; 36:415-422. [PMID: 35234081 DOI: 10.1177/19458924211069213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure. We investigated the optic nerve, Meckel's cavity, internal carotid artery (ICA) and pituitary findings of IIH by Cranial Magnetic Resonance Imaging (MRI). METHODS Cranial MRI images of 35 adult patients with IIH and 35 adult subjects with normal cranial MRI results (control) were evaluated. Optic nerve diameter (OND), optic nerve sheat diameter (ONSD), OND/ONSD ratio, ON tortuosity, ON protrusion, posterior scleral flattening, ICA transverse diameter, CSF distance in Meckel's cavity and ICA transverse diameter/CSF distance in Meckel's cavity ratio, and pituitary gland measurements (height and transverse dimension; and Optic chiasm- pituitary gland distance) were measured. RESULTS OND and ONSD of the IIH group were significantly higher than those of the control groups at anterior and posterior measurements (p < 0.05). OND/ONSD ratio of the IIH group was lower at anterior measurement; and higher at the posterior measurement than the control group (p < 0.05). Right ICA transverse diameter and bilateral CSF distance in Meckel's cavity of the IIH group were higher than those of the control. Optic chiasm- pituitary gland distance of the IIH group was significantly higher than that of the control group (p < 0.05). CONCLUSION OND/ONSD ratio is different in anterior and posterior measurements. So we recommend measuring OND and ONSD separately in IIH patients to use in the clinical practice. Similarly, optic chiasm-pituitary gland distance is also another point to note for IIH patients on MRI. Our paper adds new approach to IIH in terms of OND/ONSD ratio.
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Affiliation(s)
- Imran Çankaya
- Faculty of Medicine, Radiology Department, Kırıkkale University, Kırıkkale, Turkey
| | - Nuray Bayar Muluk
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey
| | - Veysel Burulday
- Faculty of Medicine, Radiology Department, Inönü University, Malatya, Turkey
| | | | - Adnan Özdemir
- Faculty of Medicine, Radiology Department, Kırıkkale University, Kırıkkale, Turkey
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Altunisik E, Sut SK, Sahin S, Baykan AH. Is Increased Intracranial Pressure a Factor in Persistent Headache After Coronavirus Disease 2019? J Nerv Ment Dis 2021; 209:640-644. [PMID: 34280176 PMCID: PMC8407289 DOI: 10.1097/nmd.0000000000001393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT This study aimed to determine pain characteristics in patients with persistent headache after COVID-19 and to investigate the role of increased intracranial pressure (ICP) in the pathogenesis of this headache. This is a case-control study comparing the parameters and measurements indicating increased ICP based on magnetic resonance imaging between COVID-19-diagnosed patients with persistent headache and a control group. Optic nerve sheath diameter (ONSD) and eyeball transverse diameter (ETD) were performed on the left eye of each participant. Seventeen of the patients (53.12%) met the diagnostic criteria for new daily persistent headache. Seven patients (21.87%) had migraine, and eight (25%) had tension headache characteristics. No significant difference was observed between the patient and control groups in terms of the ONSD and ETD values. It is possible that the etiopathogenesis is multifactorial. We consider that future studies that will evaluate ICP measurements in large patient groups can present a different perspective for this subject.
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Affiliation(s)
| | - Suat Kamil Sut
- Radiology, Adiyaman University Faculty of Medicine, Adiyaman, Turkey
| | - Sukru Sahin
- Radiology, Adiyaman University Faculty of Medicine, Adiyaman, Turkey
| | - Ali Haydar Baykan
- Radiology, Adiyaman University Faculty of Medicine, Adiyaman, Turkey
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Abdallah A. Correlation of hydromyelia with subarachnoid hemorrhage-related hydrocephalus: an experimental study. Neurosurg Rev 2020; 44:1437-1445. [PMID: 32514658 DOI: 10.1007/s10143-020-01330-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/25/2020] [Accepted: 06/03/2020] [Indexed: 11/27/2022]
Abstract
Although the central canal is an integral component of the cerebral ventricular system, central canal dilation has not been examined adequately during the progression of subarachnoid hemorrhage-related hydrocephalus (SAH-H). Central canal dilation-associated ependymal cell desquamation or subependymal membrane rupture has been rarely reported. Herein, we try to describe possible mechanisms of central canal dilation "Hydromyelia," developing after SAH. A total of 25 New Zealand hybrid female rabbits were recruited. Five served as controls, and five received sham operations. In the remaining animals (n = 15), 0.5 mL/kg of autologous blood was injected into the cisterna magna twice on 0 and 2nd days. Five of these animals died within a few days. A total of 10 survivor animals decapitated 3 weeks later, and the brains and cervical spinal cords were histologically examined. Central canal volumes, ependymal cell numbers on the canal surfaces, and the Evans' indices of the ventricles were compared. On histological examination, central canal occlusion with desquamated ependymal cells and basement membrane rupture were evident. The mean Evans' index of the brain ventricles was 0.31, the mean central canal volume was 1.054 mm3, and the normal ependymal cell density was 4.210/mm2 in control animals; the respective values were 0.34, 1.287 mm3, and 3.602/mm2 for sham-operated animals, and 0.41, 1.776 mm3, and 2.923/mm2 in the study group. The differences were statistically significant (p < 0.05). Hydromyelia, an ignored complication of SAH-H, features ependymal cell desquamation, subependymal basement membrane destruction, blood cell accumulation on the subependymal cell basement membrane, and increased CSF pressure. Hydromyelia may be a significant complication following SAH.
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Affiliation(s)
- Anas Abdallah
- Department of Neurosurgery, Bezmialem Vakif University, Adnan Menderes Bulvari, Vatan Street, 34093 Fatih, Istanbul, Turkey.
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Meiburger KM, Naldi A, Michielli N, Coppo L, Fassbender K, Molinari F, Lochner P. Automatic Optic Nerve Measurement: A New Tool to Standardize Optic Nerve Assessment in Ultrasound B-Mode Images. Ultrasound Med Biol 2020; 46:1533-1544. [PMID: 32147099 DOI: 10.1016/j.ultrasmedbio.2020.01.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/25/2020] [Accepted: 01/31/2020] [Indexed: 06/10/2023]
Abstract
Transorbital sonography provides reliable information about the estimation of intra-cranial pressure by measuring the optic nerve sheath diameter (ONSD), whereas the optic nerve (ON) diameter (OND) may reveal ON atrophy in patients with multiple sclerosis. Here, an AUTomatic Optic Nerve MeAsurement (AUTONoMA) system for OND and ONSD assessment in ultrasound B-mode images based on deformable models is presented. The automated measurements were compared with manual ones obtained by two operators, with no significant differences. AUTONoMA correctly segmented the ON and its sheath in 71 out of 75 images. The mean error compared with the expert operator was 0.06 ± 0.52 mm and 0.06 ± 0.35 mm for the ONSD and OND, respectively. The agreement between operators and AUTONoMA was good and a positive correlation was found between the readers and the algorithm with errors comparable with the inter-operator variability. The AUTONoMA system may allow for standardization of OND and ONSD measurements, reducing manual evaluation variability.
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Affiliation(s)
- Kristen M Meiburger
- PoliToBIOMed Lab, Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy.
| | - Andrea Naldi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Nicola Michielli
- PoliToBIOMed Lab, Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Lorenzo Coppo
- Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Klaus Fassbender
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Filippo Molinari
- PoliToBIOMed Lab, Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
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Zheng YM, Chen J, Yuan MG, Wu ZJ, Dong C. Does a change in ventricular size predict a diagnosis of cerebral venous thrombosis-related acute intracranial hypertension? Results of a retrospective imaging study. Acta Radiol 2019; 60:1308-1313. [PMID: 30638039 DOI: 10.1177/0284185118823346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Ying-Mei Zheng
- Department of Health Examination Center, The Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Jing Chen
- Deapartment of Neurology, Jinan Central Hospital Affiliated to Shandong University, Jinan, PR China
| | - Ming-Gang Yuan
- Department of Nuclear Medicine, Qingdao Central Hospital, Second Affiliated Hospital of Qingdao University, Qingdao, Shandong, PR China
| | - Zeng-Jie Wu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, PR China
| | - Cheng Dong
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, PR China
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Kozler P, Maresova D, Pokorny J. Cellular brain edema induced by water intoxication in rat experimental model. Neuro Endocrinol Lett 2018; 39:209-218. [PMID: 30431738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/02/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES This paper presents our own rat model of the cellular brain edema, induced by water intoxication (WI). The basic principle of the model is an osmotic imbalance in the cell membrane followed by an intracellular flow of sodium and simultaneous accumulation of water leading to the subsequent increase of BBB permeability. METHODS The usefulness of the model was tested in precisely specified conditions whose results were clearly expressed. The procedure determined both how WI induces cellular edema as well as the disturbances caused by cellular edema. RESULTS The evidence of existing cellular edema with increased BBB permeability was proved by intracellular accumulation of intravital dye with a large molecular size; increased brain-water content was confirmed by using the dry/wet weight method and by the decrease in CT density; the elevated intracranial pressure (ICP) due to the expanding volume was determined by continuous monitoring the ICP; the structural lesions were proved by identification of the myelin disintegration; and the impaired nervous functions was demonstrated by the of open field test method. CONCLUSION Our experimental model can help the future studies of pathophysiology of cellular brain edema and is suitable for testing neuroprotective agents.
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Affiliation(s)
- Petr Kozler
- Institute of Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Dana Maresova
- Institute of Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Jaroslav Pokorny
- Institute of Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
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Bragin DE, Statom GL, Nemoto EM. Induced Dynamic Intracranial Pressure and Cerebrovascular Reactivity Assessment of Cerebrovascular Autoregulation After Traumatic Brain Injury with High Intracranial Pressure in Rats. Acta Neurochir Suppl 2018; 126:309-312. [PMID: 29492580 DOI: 10.1007/978-3-319-65798-1_60] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE In previous work we showed that high intracranial pressure (ICP) in the rat brain induces a transition from capillary (CAP) to pathological microvascular shunt (MVS) flow, resulting in brain hypoxia, edema, and blood-brain barrier (BBB) damage. This transition was correlated with a loss of cerebral blood flow (CBF) autoregulation undetected by static autoregulatory curves but identified by induced dynamic ICP (iPRx) and cerebrovascular (iCVRx) reactivity. We hypothesized that loss of CBF autoregulation as correlated with MVS flow would be identified by iPRx and iCVRx in traumatic brain injury (TBI) with elevated ICP. METHODS TBI was induced by lateral fluid percussion (LFP) using a gas-driven device in rats. Using in vivo two-photon laser scanning microscopy, cortical microcirculation, tissue oxygenation (NADH autofluoresence), and BBB permeability (fluorescein dye extravasation) were measured before and for 4 h after TBI. Laser Doppler cortical flux, rectal and brain temperature, ICP and mean arterial pressure (MAP), blood gases, and electrolytes were monitored. Every 30 min, a transient 10 mmHg rise in MAP was induced by i.v. bolus of dopamine. iPRx = ΔICP/ΔMAP and iCVRx = ΔCBF/ΔMAP. RESULTS We demonstrated that iPRx and iCVRx correctly identified more severe loss of CBF autoregulation correlated with a transition of blood flow to MVS after TBI with high ICP compared to TBI without an increase in ICP. CONCLUSIONS In TBI with high ICP, high-velocity MVS flow is responsible for the loss of CBF autoregulation identified by iPRx and iCVRx.
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Affiliation(s)
- Denis E Bragin
- Department of Neurosurgery, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, NM, USA.
| | - Gloria L Statom
- Department of Neurosurgery, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Edwin M Nemoto
- Department of Neurosurgery, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, NM, USA
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Alluri H, Shaji CA, Davis ML, Tharakan B. A Mouse Controlled Cortical Impact Model of Traumatic Brain Injury for Studying Blood-Brain Barrier Dysfunctions. Methods Mol Biol 2018; 1717:37-52. [PMID: 29468582 DOI: 10.1007/978-1-4939-7526-6_4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide. It is a silently growing epidemic with multifaceted pathogenesis, and current standards of treatments aim to target only the symptoms of the primary injury, while there is a tremendous need to explore interventions that can halt the progression of the secondary injuries. The use of a reliable animal model to study and understand the various aspects the pathobiology of TBI is extremely important in therapeutic drug development against TBI-associated complications. The controlled cortical impact (CCI) model of TBI described here, uses a mechanical impactor to inflict a mechanical injury into the mouse brain. This method is a reliable and reproducible approach to inflict mild, moderate or severe injuries to the animal for studying TBI-associated blood-brain barrier (BBB) dysfunctions, neuronal injuries, brain edema, neurobehavioral changes, etc. The present method describes how the CCI model could be utilized for determining the BBB dysfunction and hyperpermeability associated with TBI. Blood-brain barrier disruption is a hallmark feature of the secondary injury that occur following TBI, frequently associated with leakage of fluid and proteins into the extravascular space leading to vasogenic edema and elevation of intracranial pressure. The method described here focuses on the development of a CCI-based mouse model of TBI followed by the evaluation of BBB integrity and permeability by intravital microscopy as well as Evans Blue extravasation assay.
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Affiliation(s)
- Himakarnika Alluri
- Department of Surgery, Texas A&M University Health Science Center, College of Medicine, Baylor Scott and White Research Institute, Temple, TX, USA
| | - Chinchusha Anasooya Shaji
- Department of Surgery, Texas A&M University Health Science Center, College of Medicine, Baylor Scott and White Research Institute, Temple, TX, USA
| | - Matthew L Davis
- Department of Surgery, Texas A&M University Health Science Center, College of Medicine, Baylor Scott and White Research Institute, Temple, TX, USA
| | - Binu Tharakan
- Department of Surgery, Texas A&M University Health Science Center, College of Medicine, Baylor Scott and White Research Institute, Temple, TX, USA.
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Smith ME, Eskandari R. A novel technology to model pressure-induced cellular injuries in the brain. J Neurosci Methods 2018; 293:247-253. [PMID: 28993205 DOI: 10.1016/j.jneumeth.2017.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 08/02/2017] [Accepted: 10/03/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Elevated intracranial pressure (ICP) accompanying a number of neurological emergencies is poorly understood, and lacks a model to determine cellular pathophysiology. This limits our ability to identify cellular and molecular biomarkers associated with the pathological progression from physiologic to pathologic ICP. NEW METHOD We developed an ex vivo model of pressure-induced brain injury, which combines 3D neural cell cultures and a newly developed Pressure Controlled Cell Culture Incubator (PC3I). Human astrocytes and neurons maintained in 3D peptide-conjugated alginate hydrogels were subjected to pressures that mimic both physiologic and pathologic levels of ICP for up to 48h to evaluate the earliest impacts of isolated pressure on cellular viability and quantify early indicators of pressure-induced cellular injury. RESULTS Compared to control cell cultures grown under physiologic pressure, sustained pathologic pressure exposure increased the release of intracellular ATP in a cell-specific manner. Eighteen hours of sustained pressure resulted in increased ATP release from neurons but not astrocytes. COMPARISON WITH EXISTING METHODS Cell culture incubators maintain cultures at normal atmospheric pressure. Based on multiple literature searches, we are not aware of any other cell culture incubator systems that modify the pressure at which primary CNS cells are maintained. CONCLUSION This model simulates the clinical features of elevated ICP encountered in patients with hydrocephalus, and provides a first estimate of the pathological signaling encountered during the earliest perid of progression in neonatal hydrocephalus. This model should provide a means to better understand the pathological biomarkers associated with the earliest stages of elevated ICP.
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Affiliation(s)
- Michael E Smith
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Ramin Eskandari
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC 29425, USA; Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA.
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Jeon JP, Lee SU, Kim SE, Kang SH, Yang JS, Choi HJ, Cho YJ, Ban SP, Byoun HS, Kim YS. Correlation of optic nerve sheath diameter with directly measured intracranial pressure in Korean adults using bedside ultrasonography. PLoS One 2017; 12:e0183170. [PMID: 28902893 PMCID: PMC5597178 DOI: 10.1371/journal.pone.0183170] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 07/31/2017] [Indexed: 12/18/2022] Open
Abstract
Objectives The correlation of optic nerve sheath diameter (ONSD) as seen on ultrasonography (US) and directly measured intracranial pressure (ICP) has been well described. Nevertheless, differences in ethnicity and type of ICP monitor used are obstacles to the interpretation. Therefore, we investigated the direct correlation between ONSD and ventricular ICP and defined an optimal cut-off point for identifying increased ICP (IICP) in Korean adults with brain lesions. Methods This prospective study included patients who required an external ventricular drainage (EVD) catheter for ICP control. IICP was defined as an opening pressure over 20 mmHg. ONSD was measured using a 13 MHz US probe before the procedure. Linear regression analysis and receiver operator characteristic (ROC) curve were used to assess the association between ONSD and ICP. Optimal cut-off value for identifying IICP was defined. Results A total of 62 patients who underwent ONSD measurement with simultaneous EVD catheter placement were enrolled in this study. Thirty-two patients (51.6%) were found to have IICP. ONSD in patients with IICP (5.80 ± 0.45 mm) was significantly higher than in those without IICP (5.30 ± 0.61 mm) (P < 0.01). The IICP group showed more significant linear correlation with ONSD (r = 0.57, P < 0.01) compared to the non-IICP group (r = 0.42, P = 0.02). ONSD > 5.6 mm disclosed a sensitivity of 93.75% and a specificity of 86.67% for identifying IICP. Conclusion ONSD as seen on bedside US correlated well with directly measured ICP in Korean adults with brain lesions. The optimal cut-off point of ONSD for detecting IICP was 5.6 mm.
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Affiliation(s)
- Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
- New Frontier Research Institute, Hallym University College of Medicine, Chuncheon, Korea
| | - Si Un Lee
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung-Eun Kim
- Department of Emergency Medicine, Seoul Emergency Operations Center, Seoul, Korea
| | - Suk Hyung Kang
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
- * E-mail:
| | - Jin Seo Yang
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Hyuk Jai Choi
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Yong Jun Cho
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Seung Pil Ban
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyoung Soo Byoun
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Soo Kim
- Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul, Korea
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Barbagallo M, Vitaliti G, Greco F, Pavone P, Matin N, Panta G, Lubrano R, Falsaperla R. Idiopathic intracranial hypertension in a paediatric population: a retrospective observational study on epidemiology, symptoms and treatment. J BIOL REG HOMEOS AG 2017; 31:195-200. [PMID: 28337892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Idiopathic intracranial hypertension (IIH) is a disorder of unknown origin, which is characterized by elevated intracranial pressure (ICP) without underlying etiological evidence of neurological disease. The purpose of the current study was to evaluate epidemiological features, clinical presentation, diagnostic findings and treatment of sixteen children (7 males and 9 females) with IIH. Medical records of the patients were obtained from the University Paediatric Hospital of Catania, Italy. Clinical features, investigations and treatment approaches were retrieved. The mean age of the sixteen children at onset of symptoms was 9 years (range: 4 to 16 years). Most of the patients were classified as pre-pubertal. Mean BMI was 28.9 kg/m2. In 93.75% of patients headache was the presenting clinical symptom; and in the same percentage papilledema was detected as the accompanied sign during diagnostic flow-chart. The mean lumbar puncture opening pressure (LPOP) was 350 mm H2O. Fifty percent of the cases had normal brain imaging, while 12.5% showed enlarged optic nerve diameter and one patient had an intraocular protrusion of the optic nerve on MRI. Two patients (12.5%) had venous sinus stenosis, and one case showed an abnormal spinal MRI. With regard to therapeutic approaches, 93.75% of the cases were successfully treated with Acetazolamide. None of the patients required surgical procedures, and all neuroimaging findings disappeared after receiving treatment. In the present study we investigated the association of IIH with venous sinus stenosis. We also found ocular ultrasound to be a useful non-invasive alternative method for determining papilledema in paediatric IIH, specifically in an emergency.
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Affiliation(s)
- M Barbagallo
- General Paediatrics O.U., Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi, Catania, Italy
| | - G Vitaliti
- General Paediatrics O.U., Policlinico-Vittorio Emanuele University Hospital, University of Catania, Italy
| | - F Greco
- General Paediatrics O.U., Policlinico-Vittorio Emanuele University Hospital, University of Catania, Italy
| | - P Pavone
- General Paediatrics O.U., Policlinico-Vittorio Emanuele University Hospital, University of Catania, Italy
| | - N Matin
- Tehran University of Medical Sciences, Tehran, Iran; 4Pediatric Nephrology O.U., La Sapienza University of Rome, Rome, Italy
| | - G Panta
- General Paediatrics O.U., Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi, Catania, Italy
| | - R Lubrano
- Pediatric Nephrology O.U., La Sapienza University of Rome, Rome, Italy
| | - R Falsaperla
- General Paediatrics O.U., Policlinico-Vittorio Emanuele University Hospital, University of Catania, Italy
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Padayachy LC, Padayachy V, Galal U, Pollock T, Fieggen AG. The relationship between transorbital ultrasound measurement of the optic nerve sheath diameter (ONSD) and invasively measured ICP in children. : Part II: age-related ONSD cut-off values and patency of the anterior fontanelle. Childs Nerv Syst 2016; 32:1779-85. [PMID: 27659820 DOI: 10.1007/s00381-016-3068-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/14/2016] [Indexed: 01/12/2023]
Abstract
PURPOSE To analyse the diagnostic accuracy of age-related optic nerve sheath diameter (ONSD) cut-off values in children for detecting raised intracranial pressure (ICP) and to assess the benefit of using patency of the anterior fontanelle in describing a different set of cut-off values. METHODS The ONSD measurement was performed prior to invasive ICP measurement in children under general anesthesia. The diagnostic accuracy of the ONSD measurement was compared to ICP at thresholds of 20, 15, 10, and 5 mmHg. This was further analysed in children above and below the age of 1 year, with a subgroup analysis of age at 4 years, and assessment of the anterior fontanelle (AF) as a reliable physiological marker in part II of this study. RESULTS Data from 174 children were analysed. In children ≤1 year old, the ONSD measurement with the best diagnostic accuracy for detecting ICP ≥ 20 mmHg was 5.16 mm, compared to 5.75 mm in children >1 year old (p < 0.001). In addition, patency of the anterior fontanelle (AF) was found to be a useful clinical marker for defining different ONSD cut-off values at ICP thresholds of 20, 15, 10 and 5 mmHg. CONCLUSION Transorbital ultrasound measurement of the ONSD is a reliable non-invasive marker of ICP particularly at higher thresholds of 20 and 15 mmHg. Patency of the AF is a useful clinical marker for defining different ONSD cut-off values in children.
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Affiliation(s)
- Llewellyn C Padayachy
- Paediatric Neurosurgery Unit, Division of Neurosurgery, Faculty of Health Sciences, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
| | - Vaishali Padayachy
- Trauma Unit, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Ushma Galal
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Travis Pollock
- Paediatric Opthalmology Unit, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - A Graham Fieggen
- Paediatric Neurosurgery Unit, Division of Neurosurgery, Faculty of Health Sciences, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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Dong C, Zheng YM, Li XL, Wang HX, Hao DP, Nie P, Pang J, Xu WJ. Morphometric MRI changes in intracranial hypertension due to cerebral venous thrombosis: a retrospective imaging study. Clin Radiol 2016; 71:691-7. [PMID: 27180083 DOI: 10.1016/j.crad.2016.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/07/2016] [Accepted: 04/06/2016] [Indexed: 02/07/2023]
Abstract
AIM To evaluate whether some magnetic resonance imaging (MRI) signs suggesting idiopathic intracranial hypertension (IIH) could also be found in intracranial hypertension (IH) due to cerebral venous thrombosis (CVT) and to assess their possible contribution to diagnosing this disorder. MATERIALS AND METHODS Thirty-one patients with IH due to CVT were evaluated prospectively using MRI. A group of 33 age- and sex-matched healthy volunteers served as controls. The optic nerve and sheath, pituitary gland, and ventricles were assessed. The prevalence of each imaging feature was compared between the two groups. RESULTS Optic nerve sheath (ONS) dilatation and decreased pituitary gland height were the most valid signs suggesting IH in CVT patients: sensitivity 70.97% and 87.1%, respectively; specificity 96.97% and 72.73%, respectively; area under the curve 0.840 and 0.809, respectively. The MRI finding that showed the strongest association with IH in CVT patients was ONS dilatation (odds ratio 78.5). CONCLUSIONS The combination of T1-weighted volumetric MRI and magnetic resonance venography could be helpful for diagnosing IH with CVT. Abnormalities of the ONS and the pituitary gland were reliable diagnostic signs for IH due to CVT.
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Affiliation(s)
- Cheng Dong
- Department of Radiology, The Affiliated Hospital of Qingdao University, NO.16, Jiangsu Road, Qingdao 266000, China
| | - Ying-Mei Zheng
- Department of Health Examination Center, The Affiliated Hospital of Qingdao University, NO.16, Jiangsu Road, Qingdao 266000, China
| | - Xiao-Li Li
- Department of Radiology, The Affiliated Hospital of Qingdao University, NO.16, Jiangsu Road, Qingdao 266000, China
| | - He-Xiang Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, NO.16, Jiangsu Road, Qingdao 266000, China
| | - Da-Peng Hao
- Department of Radiology, The Affiliated Hospital of Qingdao University, NO.16, Jiangsu Road, Qingdao 266000, China
| | - Pei Nie
- Department of Radiology, The Affiliated Hospital of Qingdao University, NO.16, Jiangsu Road, Qingdao 266000, China
| | - Jing Pang
- Department of Radiology, The Affiliated Hospital of Qingdao University, NO.16, Jiangsu Road, Qingdao 266000, China
| | - Wen-Jian Xu
- Department of Radiology, The Affiliated Hospital of Qingdao University, NO.16, Jiangsu Road, Qingdao 266000, China.
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Miranda Bacallado Y, González Hernández A, Curutchet Mesner L, Rúa-Figueroa Fernández de Larrinoa I. Bilateral papilloedema as the initial manifestation of spinal ependymoma. Neurologia 2016; 33:194-196. [PMID: 26971061 DOI: 10.1016/j.nrl.2015.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 12/30/2015] [Indexed: 01/31/2023] Open
Affiliation(s)
- Y Miranda Bacallado
- Sección de Neurología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España.
| | - A González Hernández
- Sección de Neurología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España
| | - L Curutchet Mesner
- Oftalmología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España
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Madison AM, Sharma A, Haidekker MA. Noninvasive assessment of intracranial pressure in dogs by use of biomechanical response behavior, diagnostic imaging, and finite element analysis. Am J Vet Res 2015. [PMID: 26207964 DOI: 10.2460/ajvr.76.8.667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED 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. SAMPLE MRI data for 5 dogs. PROCEDURES 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. RESULTS 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. CONCLUSIONS AND CLINICAL RELEVANCE 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.
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Nikitin AS, Petrikov SS, Burov SA, Asratyan SA. [MONITORING OF INTRACRANIAL PRESSURE IN PATIENTS WITH MASSIVE ISCHEMIC STROKE]. Anesteziol Reanimatol 2015; 60:39-43. [PMID: 26415295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE OF THE STUDY To assess the role of monitoring of intracranial pressure (ICP) in patients with massive ischemic stroke within the first 5 days of the onset of the disease. MATERIAL AND METHODS We have analyzed the results of monitoring of intracranial pressure in 10 patients with massive ischemic stroke and compared dynamics of ICP with the dynamics of intracranial pressure and the level of consciousness and dislocation of the brain according to CT RESULTS: Dislocation syndrome decompensation occurred in 6 patients, of which only 3 patients had increased intracranial pressure greater than 20 mm Hg with oppression of the level of consciousness to moderate coma and deeper The average value of transverse dislocation in these patients at the same time amounted to 17 mm. In 2 patients with atrophy of the brain we observed ICP increase over 20 mmHg. The average value of transverse dislocation in these patients was 12 mm. Conclusion: Increased intracranial pressure greater than 20 mm Hg in patients with massive ischemic stroke can occur even when the oppression of the level of consciousness to moderate coma and deeper on the background of the dislocation of the brain. In case of an atrophy of the brain, the level of ICP may not exceed 20 mm Hg even with dislocation syndrome decompensation.
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Abstract
Acute-on-chronic liver failure (ACLF) is a newly defined clinical entity with significant morbidity and mortality (~40-90% at 1 year dependent on need for organ support at presentation). It defines a presentation with acute severe liver injury, often with multiorgan dysfunction, on a background of previously known or unknown cirrhosis. In its severest form, it is almost indistinguishable from acute liver failure, as similarly in around 5% may rapidly progress to intracranial hypertension and cerebral oedema culminating in coma and/or death. Our understanding of such cerebral sequelae is currently limited to clinical observation, though our knowledge base is rapidly expanding since recent consensus clinical definition and guidance. Moreover, there are now animal models of ACLF and imaging modalities to better characterize events in the brain that occur with ACLF. However, as yet there has been little in the way of interventional study of this condition which are much needed. In this review we dissect existing clinical and experimental data to better characterise the manifestations of ACLF on the brain and allow for the development of targeted therapy as currently the plethora of existing interventions were designed to treat either the effects of cirrhosis or acute liver injury independently.
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Affiliation(s)
- Gavin Wright
- Institute for Liver and Digestive Health, Liver Failure Group, UCL Institute of Hepatology, The Royal Free Hospital, Upper Third UCL Medical School, Pond Street, London, NW3 2PF UK
- Basildon & Thurrock University Hospitals NHS Foundation Trust Nethermayne, Essex, SS16 5NL Basildon UK
| | - Yalda Sharifi
- Institute for Liver and Digestive Health, Liver Failure Group, UCL Institute of Hepatology, The Royal Free Hospital, Upper Third UCL Medical School, Pond Street, London, NW3 2PF UK
| | - Maria Jover-Cobos
- Institute for Liver and Digestive Health, Liver Failure Group, UCL Institute of Hepatology, The Royal Free Hospital, Upper Third UCL Medical School, Pond Street, London, NW3 2PF UK
| | - Rajiv Jalan
- Institute for Liver and Digestive Health, Liver Failure Group, UCL Institute of Hepatology, The Royal Free Hospital, Upper Third UCL Medical School, Pond Street, London, NW3 2PF UK
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Liu P, Zhang M, Shoeb M, Hogan D, Tang L, Syed MF, Wang CZ, Campbell GA, Ansari NH. Metal chelator combined with permeability enhancer ameliorates oxidative stress-associated neurodegeneration in rat eyes with elevated intraocular pressure. Free Radic Biol Med 2014; 69:289-99. [PMID: 24509160 PMCID: PMC4005814 DOI: 10.1016/j.freeradbiomed.2014.01.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 01/21/2014] [Accepted: 01/29/2014] [Indexed: 10/25/2022]
Abstract
Because as many as half of glaucoma patients on intraocular pressure (IOP)-lowering therapy continue to experience optic nerve toxicity, it is imperative to find other effective therapies. Iron and calcium ions play key roles in oxidative stress, a hallmark of glaucoma. Therefore, we tested metal chelation by means of ethylenediaminetetraacetic acid (EDTA) combined with the permeability enhancer methylsulfonylmethane (MSM) applied topically on the eye to determine if this noninvasive treatment is neuroprotective in rat optic nerve and retinal ganglion cells exposed to oxidative stress induced by elevated IOP. Hyaluronic acid (HA) was injected into the anterior chamber of the rat eye to elevate the IOP. EDTA-MSM was applied topically to the eye for 3 months. Eyeballs and optic nerves were processed for histological assessment of cytoarchitecture. Protein-lipid aldehyde adducts and cyclooxygenase-2 (COX-2) were detected immunohistochemically. HA administration increased IOP and associated oxidative stress and inflammation. Elevated IOP was not affected by EDTA-MSM treatment. However, oxidative damage and inflammation were ameliorated as reflected by a decrease in formation of protein-lipid aldehyde adducts and COX-2 expression, respectively. Furthermore, EDTA-MSM treatment increased retinal ganglion cell survival and decreased demyelination of optic nerve compared with untreated eyes. Chelation treatment with EDTA-MSM ameliorates sequelae of IOP-induced toxicity without affecting IOP. Because most current therapies aim at reducing IOP and damage occurs even in the absence of elevated IOP, EDTA-MSM has the potential to work in conjunction with pressure-reducing therapies to alleviate damage to the optic nerve and retinal ganglion cells.
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Affiliation(s)
- P Liu
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch, Galveston, TX 77555-0647, USA
| | - M Zhang
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch, Galveston, TX 77555-0647, USA
| | - M Shoeb
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch, Galveston, TX 77555-0647, USA
| | - D Hogan
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch, Galveston, TX 77555-0647, USA
| | - Luosheng Tang
- Ophthalmology Department, Second Xiangya Hospital, Central South University, Changsha 410011, People's Republic of China
| | - M F Syed
- Department of Ophthalmology & Visual Science, University of Texas Medical Branch, Galveston, TX 77555-0647, USA
| | - C Z Wang
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch, Galveston, TX 77555-0647, USA
| | - G A Campbell
- Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555-0647, USA
| | - N H Ansari
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch, Galveston, TX 77555-0647, USA.
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Bratton EW, El Husseini N, Chastain CA, Lee MS, Poole C, Stürmer T, Juliano JJ, Weber DJ, Perfect JR. Comparison and temporal trends of three groups with cryptococcosis: HIV-infected, solid organ transplant, and HIV-negative/non-transplant. PLoS One 2012; 7:e43582. [PMID: 22937064 PMCID: PMC3427358 DOI: 10.1371/journal.pone.0043582] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 07/23/2012] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The Infectious Disease Society of America (IDSA) 2010 Clinical Practice Guidelines for the management of cryptococcosis outlined three key populations at risk of disease: (1) HIV-infected, (2) transplant recipient, and (3) HIV-negative/non-transplant. However, direct comparisons of management, severity and outcomes of these groups have not been conducted. METHODOLOGY/PRINCIPAL FINDINGS Annual changes in frequency of cryptococcosis diagnoses, cryptococcosis-attributable mortality and mortality were captured. Differences examined between severe and non-severe disease within the context of the three groups included: demographics, symptoms, microbiology, clinical management and treatment. An average of nearly 15 patients per year presented at Duke University Medical Center (DUMC) with cryptococcosis. Out of 207 study patients, 86 (42%) were HIV-positive, 42 (20%) were transplant recipients, and 79 (38%) were HIV-negative/non-transplant. HIV-infected individuals had profound CD4 lymphocytopenia and a majority had elevated intracranial pressure. Transplant recipients commonly (38%) had renal dysfunction. Nearly one-quarter (24%) had their immunosuppressive regimens stopped or changed. The HIV-negative/non-transplant population reported longer duration of symptoms than HIV-positive or transplant recipients and 28% (22/79) had liver insufficiency or underlying hematological malignancies. HIV-positive and HIV-negative/non-transplant patients accounted for 89% of severe disease cryptococcosis-attributable deaths and 86% of all-cause mortality. CONCLUSIONS/SIGNIFICANCE In this single-center study, the frequency of cryptococcosis did not change in the last two decades, although the underlying case mix shifted (fewer HIV-positive cases, stable transplant cases, more cases with neither). Cryptococcosis had a relatively uniform and informed treatment strategy, but disease-attributable mortality was still common.
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Affiliation(s)
- Emily W. Bratton
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Nada El Husseini
- Department of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Cody A. Chastain
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Michael S. Lee
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Charles Poole
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Til Stürmer
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jonathan J. Juliano
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - David J. Weber
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - John R. Perfect
- Department of Medicine, Duke University, Durham, North Carolina, United States of America
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De Simone R, Ranieri A, Montella S, Marchese M, Persico P, Bonavita V. Sinus venous stenosis, intracranial hypertension and progression of primary headaches. Neurol Sci 2012; 33 Suppl 1:S21-5. [PMID: 22644164 DOI: 10.1007/s10072-012-1037-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The recently advanced hypothesis that idiopathic intracranial hypertension without papilledema (IIHWOP) is a powerful risk factor for the progression of pain in individuals prone to episodic primary headache implies that IIHWOP is much more prevalent than it is believed to be in the general population and that it can run almost asymptomatic in most of the affected individuals. In this review, we discuss the evidence available supporting that: (a) sinus venous stenosis-associated IIHWOP is much more prevalent than believed in the general population and can run without symptoms or signs of raised intracranial pressure in most of individuals affected, (b) sinus venous stenosis is a very sensitive and specific predictor of intermittent or continuous idiopathic intracranial hypertension with or without papilledema, even in asymptomatic individuals, (c) in primary headache prone individuals, a comorbidity with a hidden stenosis-associated IIHWOP represents a very common, although largely underestimated, modifiable risk factor for the progression and refractoriness of headache.
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Affiliation(s)
- Roberto De Simone
- Headache Centre, Department of Neurological Sciences, University of Naples Federico II, via Pansini 5, 80131 Naples, Italy.
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Schmidt C, Wiener E, Hoffmann J, Klingebiel R, Schmidt F, Hofmann T, Harms L, Kunte H. Structural olfactory nerve changes in patients suffering from idiopathic intracranial hypertension. PLoS One 2012; 7:e35221. [PMID: 22493741 PMCID: PMC3320869 DOI: 10.1371/journal.pone.0035221] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Accepted: 03/13/2012] [Indexed: 01/18/2023] Open
Abstract
Background Complications of idiopathic intracranial hypertension (IIH) are usually caused by elevated intracranial pressure (ICP). In a similar way as in the optic nerve, elevated ICP could also compromise the olfactory nerve system. On the other side, there is growing evidence that an extensive lymphatic network system around the olfactory nerves could be disturbed in cerebrospinal fluid disorders like IIH. The hypothesis that patients with IIH suffer from hyposmia has been suggested in the past. However, this has not been proven in clinical studies yet. This pilot study investigates whether structural changes of the olfactory nerve system can be detected in patients with IIH. Methodology/Principal Findings Twenty-three patients with IIH and 23 matched controls were included. Olfactory bulb volume (OBV) and sulcus olfactorius (OS) depth were calculated by magnetic resonance techniques. While mean values of total OBV (128.7±38.4 vs. 130.0±32.6 mm3, p=0.90) and mean OS depth (8.5±1.2 vs. 8.6±1.1 mm, p=0.91) were similar in both groups, Pearson correlation showed that patients with a shorter medical history IIH revealed a smaller OBV (r=0.53, p<0.01). In untreated symptomatic patients (n=7), the effect was greater (r=0.76, p<0.05). Patients who suffered from IIH for less than one year (n=8), total OBV was significantly smaller than in matched controls (116.6±24.3 vs. 149.3±22.2 mm3, p=0.01). IIH patients with visual disturbances (n=21) revealed a lower OS depth than patients without (8.3±0.9 vs. 10.8±1.0 mm, p<0.01). Conclusions/Significance The results suggest that morphological changes of the olfactory nerve system could be present in IIH patients at an early stage of disease.
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Affiliation(s)
- Christoph Schmidt
- Institute of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Edzard Wiener
- Institute of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Hoffmann
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Randolf Klingebiel
- Institute of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Schmidt
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Hofmann
- Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Lutz Harms
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hagen Kunte
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
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Chen J, Wang XM, Luan LM, Chao BT, Pang B, Song H, Pang Q. Biological characteristics of the cerebral venous system and its hemodynamic response to intracranial hypertension. Chin Med J (Engl) 2012; 125:1303-1309. [PMID: 22613606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The role of the cerebral venous system (CVS) in intracranial pressure (ICP) regulation remains largely unclear. In the present study, the interaction between ICP and the cerebral venous system and its possible mechanism were investigated with respect to the biological characteristics of the cerebral venous system and its hemodynamic response under increased ICP. METHODS We created intracranial hypertension animal model, measured and calculated the venous flow velocity and diameter of the outflow terminal of the CVS with color ultrasonic system and recorded the vascular morphology by 3-dimensional anatomical microscopy. Patients who suffered from raised ICP underwent MRI and digital subtraction angiography (DSA) examination to show the length in the vertical direction of the wall of the bridging vein representing the diameter value. Pathological autopsy was performed from bodies of patients who had died from non-cerebral causes to observe the juncture part between the venous sinuses and tributary vertical brain veins. RESULTS Under increased ICP conditions, venous drainage through the outlet cuff segment, a unique structure between the bridge vein and sinus, was obstructed and in turn venous blood became congested. Therefore, the increased blood volume worsened the pre-existing ICP according to the well-accepted theory regarding volume-pressure relationship. This phenomenon was described as concurrent "venogenic intracranial hypertension", which is characterized by intracranial venous blood stasis responsive to and together with the original increased ICP. CONCLUSIONS The existence of this special pathophysiological process is prevalent, rather than rare, in various intracranial disorders. This finding would definitely provide new insight into the area of cerebral venous system research.
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Affiliation(s)
- Jie Chen
- Shandong Medical Imaging Research Institute, Shandong University, Ji'nan, Shandong, China
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Hessler C, Hamel W, Kluge S, Mayer U, Grzyska U, Westphal M, Püschel K. [Fatal crossbow injury in an adolescent]. Arch Kriminol 2012; 229:90-95. [PMID: 22611907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The authors present the case of a 14-year-old boy who died while handling a crossbow, which was a gift from a friend's mother. The bolt passed through the right nostril, penetrated the sinus sphenoidalis, the brain stem, the left occipital lobe and the occipital calvaria. Immediately after the accident, the victim was taken to a maximum care hospital. In spite of neurosurgical treatment and intensive care the victim died 4 days later. The case presented demonstrates that crossbows are not suitable as toys for underage persons, as they are deadly weapons which can cause serious penetrating injuries. In Germany, no license is required to buy and/or possess crossbows. In the authors' opinion, legal restrictions on the sale of crossbows and a special training of the users would be reasonable measures to reduce such accidents.
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Affiliation(s)
- Christian Hessler
- Klinik für Neurochirurgie des Universitätsklinikum Hamburg-Eppendorf
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28
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Graffe A, Giraudet S, Lecq A, Adenis JP, Milea D. [Optociliary shunt vessels regression after optic nerve sheath fenestration in raised intracranial pressure]. Rev Neurol (Paris) 2010; 166:1032-3. [PMID: 21056444 DOI: 10.1016/j.neurol.2010.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 07/12/2010] [Accepted: 07/19/2010] [Indexed: 11/28/2022]
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Brouwer MJ, de Vries LS, Pistorius L, Rademaker KJ, Groenendaal F, Benders MJNL. Ultrasound measurements of the lateral ventricles in neonates: why, how and when? A systematic review. Acta Paediatr 2010; 99:1298-306. [PMID: 20394588 DOI: 10.1111/j.1651-2227.2010.01830.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Germinal matrix-intraventricular haemorrhage and subsequent post-haemorrhagic ventricular dilatation (PHVD) are frequently encountered complications in preterm neonates. As progressive dilatation of the lateral ventricles may be associated with elevated intracranial pressure, ultrasound measurements of ventricular size play a major role in the evaluation of neonates at risk of ventricular dilatation as well as in assessing the effect of intervention for PHVD. A systematic search was carried out in Medline and Embase to identify neonatal and foetal ultrasound studies on lateral ventricular size. This review presents an overview of the available data concerning neonatal reference values for lateral ventricular size, the influence of gender, ventricular asymmetry and the effect of the mode of delivery on the phenomenon of ventricular reopening following birth. CONCLUSION Serial cranial ultrasound measurements of the lateral ventricles play a key role in the early recognition and therapeutic evaluation of post-haemorrhagic ventricular dilation and can be of prognostic value in neonates with ventricular dilatation.
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Affiliation(s)
- Margaretha J Brouwer
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
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Szitkar B. A meningioma exclusively located inside the superior sagittal sinus responsible for intracranial hypertension. AJNR Am J Neuroradiol 2010; 31:E57-8. [PMID: 20430852 DOI: 10.3174/ajnr.a2130] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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31
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Vrettou CS, Stavrinou LC, Halikias S, Kyriakopoulou M, Kollias S, Stranjalis G, Koutsoukou A. Factor XIII deficiency as a potential cause of supratentorial haemorrhage after posterior fossa surgery. Acta Neurochir (Wien) 2010; 152:529-32. [PMID: 19557304 DOI: 10.1007/s00701-009-0432-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Accepted: 06/01/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postoperative intracranial haemorrhage can be a dramatic event, carrying significant morbidity and mortality. Bleeding at sites remote from the operation area represents a small percentage of haemorrhages whose aetiology remains unclear (Harders et al. Acta Neurochir (Wien) 74(1-2):57-60, 1985). AIM We present the case of a 60-year-old patient who underwent posterior fossa craniotomy for the removal of a space-occupying lesion and suffered supratentorial haemorrhage soon after the operation. RESULTS A thorough postoperative investigation revealed low levels of factor XIII (FXIII), the factor mainly responsible for fibrin clot stabilisation. CONCLUSION We suggest that reduced FXIII activity may be an important but preventable predisposing factor to remote postoperative haemorrhage in neurosurgical patients.
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Affiliation(s)
- Charikleia Spyridon Vrettou
- Critical Care Department and Pulmonary Services, Evangelismos General Hospital, University of Athens Medical School, Athens GR-10675, Greece.
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32
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Unterhofer C, Chemelli A, Waldenberger P, Bauer R, Ortler M. Traumatic fistula between the middle meningeal artery and the sphenoparietal sinus. Acta Neurochir (Wien) 2009; 151:1301-4. [PMID: 19468680 DOI: 10.1007/s00701-009-0251-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Accepted: 02/21/2009] [Indexed: 11/29/2022]
Abstract
PURPOSE Post-traumatic fistulas between the middle meningeal artery and the cranial venous system are extremely rare. We describe clinical presentation and successful endovascular management of a case of post-traumatic fistula between the middle meningeal artery and the sphenoparietal sinus. METHODS A 53-year-old man was admitted with multiple brain contusions and a temporoparietal fracture after a head trauma. On day 3 after trauma he developed unilateral signs of a cavernous sinus syndrome. Digital subtraction angiography showed a fistula between the middle meningeal artery and the sphenoparietal sinus. RESULTS The fistula was occluded by endovascular coil embolization, resulting in complete remission of the clinical symptoms. CONCLUSION A high index of suspicion is necessary to detect subtle signs of venous congestion of the cavernous sinus in an intubated patient. Angiography is the diagnostic modality of choice and should include the selective investigation of the external carotid artery vascular territory. Endovascular therapy provides minimal invasive and definitive treatment of this rare condition.
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MESH Headings
- Accidents, Traffic
- Arteriovenous Fistula/diagnostic imaging
- Arteriovenous Fistula/etiology
- Arteriovenous Fistula/pathology
- Bicycling/injuries
- Brain Injuries/complications
- Brain Injuries/diagnostic imaging
- Brain Injuries/pathology
- Cavernous Sinus Thrombosis/etiology
- Cavernous Sinus Thrombosis/physiopathology
- Cavernous Sinus Thrombosis/therapy
- Cerebral Angiography
- Cranial Sinuses/diagnostic imaging
- Cranial Sinuses/injuries
- Cranial Sinuses/pathology
- Embolization, Therapeutic
- Exophthalmos/etiology
- Exophthalmos/pathology
- Exophthalmos/physiopathology
- Facial Bones/injuries
- Head Injuries, Closed/complications
- Head Injuries, Closed/diagnostic imaging
- Head Injuries, Closed/pathology
- Hematoma, Epidural, Cranial/diagnostic imaging
- Hematoma, Epidural, Cranial/pathology
- Hematoma, Epidural, Cranial/physiopathology
- Hematoma, Subdural/diagnostic imaging
- Hematoma, Subdural/pathology
- Hematoma, Subdural/physiopathology
- Humans
- Intracranial Hypertension/diagnostic imaging
- Intracranial Hypertension/etiology
- Intracranial Hypertension/pathology
- Male
- Meningeal Arteries/diagnostic imaging
- Meningeal Arteries/injuries
- Meningeal Arteries/pathology
- Middle Aged
- Parietal Bone/injuries
- Prostheses and Implants
- Skull Fractures/complications
- Skull Fractures/diagnostic imaging
- Skull Fractures/pathology
- Temporal Bone/injuries
- Tomography, X-Ray Computed
- Treatment Outcome
- Vascular Surgical Procedures
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Affiliation(s)
- Claudia Unterhofer
- Clinical Department of Neurosurgery, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
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Staals J, van Oostenbrugge RJ, Knottnerus ILH, Rouhl RPW, Henskens LHG, Lodder J. Brain microbleeds relate to higher ambulatory blood pressure levels in first-ever lacunar stroke patients. Stroke 2009; 40:3264-8. [PMID: 19661468 DOI: 10.1161/strokeaha.109.558049] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Hypertension is an important risk factor for brain microbleeds (BMBs) in lacunar stroke patients. However, beyond the qualitative label "hypertension," little is known about the association with ambulatory blood pressure (BP) levels. METHODS In 123 first-ever lacunar stroke patients we performed 24-hour ambulatory BP monitoring after the acute stroke-phase. We counted BMBs on T2*-weighted gradient-echo MR images. Because a different etiology for BMBs according to location has been suggested, we distinguished between BMBs in deep and lobar location. RESULTS BMBs were seen in 36 (29.3%) patients. After adjusting for age, sex, number of antihypertensive drugs, asymptomatic lacunar infarcts, and white matter lesions, we found 24-hour, day, and night systolic and diastolic BP levels to be significantly associated with the presence and number of BMBs (odds ratios 1.6 to 2.3 per standard deviation increase in BP). Distinguishing between different locations, various BP characteristics were significantly associated with the presence of deep (or combined deep and lobar) BMBs, but not with purely lobar BMBs. CONCLUSIONS Our results underline the role of a high 24-hour BP load as an important risk factor for BMBs. The association of BP levels with deep but not purely lobar BMBs is in line with the idea that different vasculopathies might be involved. Deep BMBs may be a particular marker of BP-related small vessel disease, but longitudinal and larger studies are now warranted to substantiate these findings.
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Affiliation(s)
- Julie Staals
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Yilmaz C, Gulsen S, Altinors N, Caner H. Rhinorrhoea from a frontal encephalocele after reduction of high intracranial pressure. Acta Neurochir (Wien) 2008; 150:1307-8. [PMID: 19015807 DOI: 10.1007/s00701-008-0157-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Accepted: 07/15/2008] [Indexed: 11/26/2022]
Abstract
Acquired non-traumatic frontal sinus encephaloceles are very rare lesions that are usually caused by a tumour or hydrocephalus. We present a 31-year-old woman with a frontal sinus encephalocele who developed rhinorrhoea after a ventriculo-peritoneal shunt to treat her hydrocephalus and underwent radiotherapy for a tectum tumour.
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Affiliation(s)
- Cem Yilmaz
- Department of Neurosurgery, Baskent University, 06490 Ankara, Turkey.
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35
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Abstract
Benign intracranial hypertension (BIH) is a rare condition in which the pathophysiology remains unclear. Multiple theories have been proposed in the past to explain BIH. Today it is widely accepted that the condition occurs in situations where alteration of cerebrospinal fluid (CSF) reabsorption is encountered. The venous system is therefore involved and may be the common denominator of the pathophysiological theories. A distinction must be made between idiopathic benign intracranial hypertension and BIH resulting from drugs, other pathological conditions, or toxics (secondary BIH), which are reported in this paper. We emphasize the crucial role of exhaustive clinical, biological, and neuroradiological investigations aiming to establish the diagnosis of BIH.
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Affiliation(s)
- J Chazal
- Service de neurochirurgie A, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand cedex, France.
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Weber J, Nauck C, Creutz U, Al-Zain F, Pusch CM. Fronto-ethmoidal encephalocele in a historical skull with artificial deformation and no signs of chronic elevated intracranial pressure. Acta Neurochir (Wien) 2008; 150:1107-9. [PMID: 18773138 DOI: 10.1007/s00701-008-0025-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Accepted: 06/20/2008] [Indexed: 11/28/2022]
Abstract
The intentional deformation of human skulls in the living being was one of the most curious rituals performed in historical and ancient times. It is thought that these practices cause chronic elevated intracranial pressure and subsequent symptoms of cognitive impairment. In this report, we examine such an artificially deformed skull dating from the sixteenth century that in addition shows a fronto-ethmoidal encephalocele. However, although the mild encephalocele was already manifest at birth and deformation practices were performed over years, the encephalocele did not progress into a more severe status. We conclude that the intentional deformation of skulls does not lead to chronic elevated intracranial pressure and mental retardation.
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Affiliation(s)
- Jochen Weber
- Department of Neurosurgery, Trauma Center Berlin, Warener Strasse 9, 12683 Berlin, Germany.
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37
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Galluccio ST, Rai S, Sharley P. An unexpected ending: brain death following acute severe asthma. CRIT CARE RESUSC 2008; 10:235-238. [PMID: 18798723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 56-year-old woman presented to our hospital with acute severe asthma. As a consequence of severe refractory airflow limitation, moderate hypercapnia ensued for several days. Unexpectedly, the patient died as a result of brain stem herniation, in the absence of hypoxaemia, arterial hypotension or an intracranial mass lesion. We discuss the mechanisms that may have precipitated severe intracranial hypertension resulting in brain death, and the possible methods to detect and avoid such a devastating consequence.
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Eliseeva NM, Serova NK, Shifrin MA. [Confocal scanning laser retinal tomography in study of 3-D topography of the optic disk in patients with papilledema]. Zh Vopr Neirokhir Im N N Burdenko 2008:31-35. [PMID: 19065744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Confocal scanning laser tomography (CSLT) giver the opportunity to describe stereometric parameters of the optic disk in patients with different stages of papilledema. CSLT of the optic disk (Heidelberg Retina Tomograph II) was performed in 20 healthy volunteers (40 eyes) and in 85 patients with papilledema caused by cerebral tumors (8 eyes without papilledema, 52 eyes with early, 38 with moderate and 56 with severe stage of papilledema, and 9 with chronic papilledema and optic atrophy). Rim volume (RV) and disk area (DA) were measured. CSLT was performed during postoperative follow-up in 40 patients. The difference in RV (p < 0.01) and DA (p < 0.01) between normal optic disk and optic disk with early and moderate edema, and optic disk with severe edema, was significant. Stereometric parameters of optic disks measured by CSLT provide objective quantitative assessment of papilledema in patients with cerebral tumors. CSLT is especially valuable in monitoring of papilledema.
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Hill DL, Miller NR, Newman NJ, Biousse V. A patient with headache and increased intracranial pressure. Rev Neurol Dis 2008; 5:95-96. [PMID: 18660744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Donna L Hill
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
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40
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Hill DL, Miller NR, Newman NJ, Biousse V. A patient with headache and increased intracranial pressure. Rev Neurol Dis 2008; 5:90-91. [PMID: 18660742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
These 2 cases presented with acutely raised intracranial pressure and had characteristic CT and MRI changes.
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Affiliation(s)
- Donna L Hill
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
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Agrawal D, Steinbok P, Cochrane DD. Significance of beaten copper appearance on skull radiographs in children with isolated sagittal synostosis. Childs Nerv Syst 2007; 23:1467-70. [PMID: 17657498 DOI: 10.1007/s00381-007-0430-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES The significance of beaten copper appearance (BCA) on skull radiographs in children following surgery for isolated sagittal craniosynostosis has not been studied. This study was designed to look for any correlation between BCA and symptoms suggestive of intracranial hypertension in this group of patients. MATERIALS AND METHODS Forty-eight consecutive children, who were operated for isolated sagittal synostosis from 1987 to 2000 and had postoperative skull radiographs, were included. Patients were divided into: (a) BCA group (n = 20), consisting of children who had beaten copper appearance on skull radiographs at last follow up, and (b) Non-BCA group (n = 28), consisting of children who did not have this finding. Records were reviewed to look for symptoms suggestive of intracranial hypertension, such as headache, head banging, and irritability. RESULTS Median age at surgery was 4.8 months for BCA group and 4 months for the non-BCA group. Follow up ranged from 4 to 156 months with a mean of 36.2 months. Total of 28.6% (n = 6) of the children with follow up radiographs done at < or =18 months of age had BCA. The incidence of BCA increased to 83.3% in children with skull radiographs performed after 48 months of age. In 18 (90%) children, the BCA was 'diffuse' with 5 (25%) children having the maximum possible score of 8. In the BCA group, 45% (n = 9) had symptoms compared to 10.7% (n = 3) in the control group (p = 0.0068). CONCLUSIONS This study suggests a significant number of children with BCA on radiographs develop symptoms suggestive of raised ICP following surgical treatment in infancy and prolonged follow up may be warranted in this group of patients.
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Affiliation(s)
- Deepak Agrawal
- Department of Neurosurgery, Neurosciences & Gamma-Knife Centre, All India Institute of Medical Sciences, New Delhi-110029, India
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Weber J, Collmann H, Czarnetzki A, Spring A, Pusch CM. Morphometric analysis of untreated adult skulls in syndromic and nonsyndromic craniosynostosis. Neurosurg Rev 2007; 31:179-88. [PMID: 17992550 DOI: 10.1007/s10143-007-0100-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 06/25/2007] [Accepted: 07/30/2007] [Indexed: 11/26/2022]
Abstract
The aim of this study was to perform a morphometric analysis of untreated adult skulls displaying syndromic and nonsyndromic craniosynostosis. We analyzed, in detail, 42 adult craniosynostoses (18 scaphocephaly, 11 anterior plagiocephaly, 2 trigonocephaly, 9 oxycephaly, and 2 brachycephaly) from archeological (three skulls) and pathoanatomical samples (39 skulls). The univariate and bivariate measurements from the pathological skulls were compared with 40 anatomical skulls with normal cranial vault morphology. Bony signs of chronic elevated intracranial pressure (ICP) are (1) diffuse beaten copper pattern, (2) dorsum sellae erosion, (3) suture diastasis, and (4) abnormalities of venous drainage that particularly affect the sigmoid-jugular sinus complex. The mean cranial length was significantly greater in scaphocephaly than in anatomical skulls (20.3 vs 18.0 cm), and the sagittal suture was also longer (14.3 vs 11.8 cm). There were three types of suture course in the bregma region in scaphocephaly: anterior spur (28%), normal configuration (61%), and posterior spur (11%). The plagiocephaly measurements showed nonsignificant differences, and there was no correlation between the length of the anterior and middle skull base (ipsilateral anterior-posterior shortening of the skull) and incomplete or complete suture synostosis. Bony signs of chronic elevated ICP were found in 82% of cases of oxycephaly and brachycephaly. In three such cases of oxycephaly, we found a marked (1.8-2.1 cm) elevation of bregma region. One skull (Saethre-Chotzen syndrome) yielded human DNA sufficient for polymerase chain reaction (PCR)-based amplification procedures. Mutation analyses in the FGFR3 gene revealed nucleotide alterations located in the mutational hot spot at amino acid residue 250 (g.C749). The mean cranial length in adult scaphocephaly was 12% greater than anatomical skulls. A unilateral complete or incomplete coronal synostosis can be found with or without plagiocephalic deformation. Elevation of the bregma region is a bony sign of chronic elevated ICP. These data on adult craniosynostosis could be of interest for physicians dealing with craniosynostotic children.
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Affiliation(s)
- J Weber
- Department of Neurosurgery, Trauma Center Berlin, Berlin, Germany.
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Abstract
BACKGROUND - Idiopathic normal pressure hydrocephalus (iNPH) is a reversible dementia in which fronto-striatal cognitive deficits and apathy may be present. OBJECTIVES - The study investigated structural volumetric changes in iNPH, apart from ventriculomegaly. MATERIALS AND METHODS - A full-brain voxel-based morphometric analysis between 11 iNPH patients and 14 healthy controls identified regions of interest (ROIs) for manual volumetric analyses. RESULTS - Caudate and corpus callosum ROI measurements revealed diminished caudate nuclei volume in the iNPH group. CONCLUSIONS - The role of the caudate nucleus in cognitive and affective changes in iNPH should now be explored.
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Affiliation(s)
- E E DeVito
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Philipps J, Busse O. From Low to High: Late - onset intracranial hypertension after treatment of spontaneous intracranial hypotension. J Neurol 2007; 254:956-7. [PMID: 17457511 DOI: 10.1007/s00415-006-0350-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Revised: 06/29/2006] [Accepted: 07/06/2006] [Indexed: 11/25/2022]
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Abstract
The middle ear changes in Sclerosteosis and Van Buchem disease are described. Reduced bone resorption occurs due to faulty activity of the sclerostin molecule, a product of the recently discovered SOST gene in chromosome 17. Syndactyly draws attention to scleroteosis, and a conductive hearing loss develops before age six in both conditions. Acute, repeated attacks of facial palsy, similar to Bell's palsy, are usually the first symptoms in both conditions. Total facial nerve decompression can stop the attacks of facial paralysis. The hearing loss is a problem because new bone formation continues up to age 21. Life saving craniectomy becomes necessary when increased intracranial pressure develops, and this may have to repeated. The sclerostin molecule is now of major interest to the researchers who want to develop a treatment for osteoporosis.
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Mangano FT, Bradford AC, Mittler MA, Valderrama E, Schneider SJ. Astroblastoma. Case report, review of the literature, and analysis of treatment strategies. J Neurosurg Sci 2007; 51:21-7; discussion 27. [PMID: 17369788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Astroblastoma, a unique glial tumor, has been described in the literature in case reports and small series. Its rarity has prevented evidenced-based treatment stratification. An 8-year-old boy presented with signs and symptoms of raised intracranial pressure. Imaging studies of the brain demonstrated a large heterogeneously enhancing solid mass in the left frontal lobe with punctate calcifications and cystic components that created subfalcine and uncal herniation. After tumor resection, histological diagnosis revealed a high-grade cerebral astroblastoma. The child's postoperative recovery was complicated by hydrocephalus that necessitated placement of a ventriculoperitoneal shunt. Fifty-four months after undergoing gross total resection and adjuvant radiation therapy, the patient, now 12-years-old, remains tumor free and neurologically stable. Chemotherapy was reserved in the event of tumor recurrence. Since the first description of astroblastoma, its histopathological and clinical features have been debated. We review the histology, immunohistochemistry, and cytogenetics of astroblastoma as well as examine the current literature and treatment strategies for the management of both low and high-grade tumors. Continued clinical studies and longer patient follow-up with a tumor based registry would further clarify optimal treatment for this rare tumor.
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Affiliation(s)
- F T Mangano
- Department of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45267-0515, USA.
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Zinkel JL. Postischemic reperfusion: ultrastructural blood-brain barrier and hemodynamic correlative changes in an awake model of transient forebrain ischemia. Neurosurgery 2006; 59:E1152. [PMID: 17143212 DOI: 10.1227/01.neu.0000252884.42686.6e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Wiesemann E, Berding G, Goetz F, Windhagen A. Spontaneous Intracranial Hypotension: Correlation of Imaging Findings with Clinical Features. Eur Neurol 2006; 56:204-10. [PMID: 17057379 DOI: 10.1159/000096487] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Accepted: 07/20/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Spontaneous intracranial hypotension (SIH) is increasingly recognized as a clinically variable and likely underdiagnosed syndrome caused by non-traumatic CSF leaks. The aim of this study was to correlate the findings of imaging studies - magnetic resonance imaging (MRI), radionuclide cisternography - with clinical features and CSF pressure in SIH in order to improve the diagnostic yield and management in patients with SIH. METHODS Clinical case study of 10 consecutive cases of SIH, MRI, radio-isotope cisternography. RESULTS 5 out of 10 patients had unusual clinical symptoms of SIH(2 subdural haematomas, 1 gait ataxia, 1 tinnitus, 1 haemodialysis-associated headache). In 7 patients pachymeningeal gadolinium enhancement was detected in MRI accompanied by a reduced CSF opening pressure. In contrast, the 3 patients with normal MRI also had a normal CSF pressure. Radio-isotope cisternography was abnormal in all patients tested. There was no correlation between the severity of clinical symptoms and MRI or radionuclide cisternography findings. CONCLUSIONS The spectrum of clinical symptoms and imaging findings in SIH is highly variable. There- fore the diagnosis of SIH is often delayed. Radio-isotope cisternography is an important additional diagnostic method to detect CSF leaks or pathological kinetics of radio-isotope movement particularly in cases with normal MRI findings.
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Affiliation(s)
- Elke Wiesemann
- Department of Neurology, Medical School Hannover, Hannover, Germany
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Haroche J, Amoura Z, Trad SG, Wechsler B, Cluzel P, Grenier PA, Piette JC. Variability in the efficacy of interferon-α in Erdheim-Chester disease by patient and site of involvement: Results in eight patients. ACTA ACUST UNITED AC 2006; 54:3330-6. [PMID: 17009306 DOI: 10.1002/art.22165] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Erdheim-Chester disease (ECD) is a rare, non-Langerhans form of histiocytosis of unknown origin, characterized by infiltration of tissues by spumous histiocytes. ECD features heterogeneous systemic manifestations, and the general prognosis remains poor despite various treatment options. METHODS We treated 8 patients with multisystemic ECD with subcutaneous interferon-alpha (IFNalpha) at a dosage of 3-9 x 10(6) units 3 times weekly, for a median duration of 23 months (range 1-46 months). RESULTS Treatment was generally well tolerated, and side effects remained limited to fever following injections. Treatment was discontinued in 1 patient, because of severe depression. During treatment, some manifestations of ECD disappeared (i.e., xanthelasma, exophthalmos, papilledema, and intracranial hypertension). The efficacy of IFNalpha on cardiovascular ECD was variable, however. Treatment resulted in partial regression of "coated aorta" in some cases and clear failure in others; 2 patients died. The level of C-reactive protein diminished sharply in 5 patients. CONCLUSION IFNalpha might be a valuable first-line therapy for prolonged treatment of ECD. However, the efficacy of IFNalpha varies among patients and according to the sites of disease involvement, and symptoms may fail to respond to treatment, especially in patients with severe multisystemic forms of ECD with central nervous system and cardiovascular involvement.
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Josan VA, Sgouros S. Early decompressive craniectomy may be effective in the treatment of refractory intracranial hypertension after traumatic brain injury. Childs Nerv Syst 2006; 22:1268-74. [PMID: 16496158 DOI: 10.1007/s00381-006-0064-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Revised: 10/11/2005] [Indexed: 10/25/2022]
Abstract
INTRODUCTION We compared the effect of early decompressive craniectomy (<24 h) vs non-operative treatment on the outcome of children with refractory intracranial hypertension after severe traumatic brain injury. MATERIAL AND METHODS We retrospectively reviewed 12 consecutive patients treated between 1999 and 2001 for refractory intracranial hypertension after isolated severe head injury without any intracranial haematomas. In all patients, treatment included sedation, paralysis and i.v. mannitol under intracranial pressure monitoring. Early decompressive craniectomy was carried out in six patients (mean age: 13 years) at mean time from injury of 7 h (range: 2-18 h), whereas six patients (mean age: 11.5 years) were managed with non-operative treatment. The Marshall Grading system was used to score the severity of radiological abnormalities in CT scans. The Glasgow Outcome Scale (GOS) at 1-year follow-up was used as outcome measure. RESULTS The mean Marshall grade was 3 in the craniectomy group and 2 in the non-operative group. All patients in the craniectomy group survived: four patients scored 5 and two patients scored 4 on the GOS. In the non-operative group, two patients (33%) died, one of whom received late decompressive craniectomy at 9 days, while three patients scored 5 and one patient scored 3 on the GOS. CONCLUSION In children who suffered severe head injury with refractory intracranial hypertension without intracranial haematoma, early decompressive craniectomy employed in the first few hours after injury before the onset of irreversible ischaemic changes may be an effective method to treat the secondary deterioration that commonly leads to death or severe neurological deficit.
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Affiliation(s)
- V A Josan
- Department of Paediatric Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
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