How does early decompressive craniectomy influence the intracranial volume relationship in traumatic brain injury (TBI) patients?

BACKGROUND: Decompressive craniectomy (DC) is a common neurosurgical procedure involving the removal of part of the skull vault combined with subsequent duroplasty. The goal of DC is to produce extra space for the swollen brain and/or to reduce intracranial pressure. In the present study, DC was performed in order to create space for the swollen brain. AIM OF THE STUDY: to compare the volume alteration of selected intracranial fluid spaces before and after DC, to evaluate the volume of post-decompressive brain displacement (PDBD) and the largest dimension of oval craniectomy (LDOC), and to assess the early clinical effects of DC. MATERIAL AND METHODS: The study group consisted of 45 patients with traumatic brain injury (four females and 41 males, mean age 54.5 years) who underwent DC (not later than five hours after admission to hospital) due to subdural haematomas and/or haemorrhagic brain contusions localised supratentorially and diagnosed by computed tomography (CT). The mortality rate in the study group was 40%. Study calculations were performed using Praezis Plus software by Med Tatra, Zeppelin and Pax Station by Compart Medical Systems. For statistical analysis, IBM SPSS Statistics software was used. RESULTS: The DC-related additional space was responsible for a statistically significant increase in the volume of preoperatively compressed intracranial fluid spaces. The mean volume of extra space filled by the swollen brain was 42.2 ml ± 40.7. The best early treatment results were achieved in patients under the age of 55. CONCLUSIONS: DC has limited effectiveness in patients aged over 70 years. In every patient with clamped basal cisterns, a skin incision enabling appropriate LDOC should be planned before surgery. DC should be as large as possible, and the limits of its dimensions should be the limits of anatomical safety.

Malignant middle cerebral artery (MCA) infarction in people over 85 years old - Diagnosis, management and risk factors.

INTRODUCTION: Malignant ischemic stroke of the middle cerebral artery (MCA) territory causes neurological deterioration due to the effects of space occupying cerebral edema. The prognosis is poor, and death usually occurs as a result of brainstem compression. There is no information on ischemic stroke, especially the malignant ones, in patients over 85 years old. AIM: The aim of this retrospective study was to evaluate the disease course, risk factors, survival rate and treatment of MCA malignant infarction in people over 85 years old. METHOD: The medical history of 66 patients with malignant MCA stroke was analyzed. The frequency of the occurrence of the risk factors like hypertension, hyperlipidemia, atrial fibrillation, heart failure, diabetes was evaluated. Disability was measured with the use of the National Institutes of Health Stroke Scale (NIHSS). Safety and effectiveness of the anticoagulants used in the group of patients with atrial fibrillation were analyzed. Chi-quadrat test and Mann-Whitney U test were used for statistical analysis of data. We also described 85 year-old patient with malignant brain stroke who was treated neurosurgically with a positive effect. RESULTS: Atrial fibrillation was diagnosed in 65% of patients of the investigated group. There were no statistically significant changes in the survival rate between the group of patients treated with the use of mannitol and patients without this treatment. CONCLUSION: The key risk factor in this group is the atrial fibrillation. The elderly patients require an intensive monitoring of the health condition by reference to brain stroke risk factors, especially atrial fibrillation.

Discriminant Analysis of Intracranial Volumetric Variables in Patients with Normal Pressure Hydrocephalus and Brain Atrophy.

A method was developed for the computerized volumetric assessment of the intracranial cerebrospinal fluid (CSF) distribution. The study involved 62 patients differentiated into two groups: with CSF resorption disorders (normal pressure hydrocephalus - 30 patients) and without CSF resorption disorders (various types of brain atrophy - 32 patients). The goal of the study was to ascertain whether the assessment, depending on the linear discriminant analysis of volumetric brain features, could be an effective tool differentiating the two groups. Volumetric measurements were performed using VisNow software. For each patient, five features were determined and subjected to discriminant analysis: CSF volume in the subarachnoid space and basal cisterns (SV), CSF volume in the intracranial ventricular system (VV), brain volume (BV), total intracranial CSF volume (FV), and total intracranial volume (TV). Discriminant analysis enables the achievement of a high percentage of correct classification of patients to the appropriate group determined on the result of a lumbar infusion test. The discriminator, based on three features: BV, SV, and VV, showed a complete separation of the groups; irrespective of age. The squared Mahalanobis distance was 70.8. The results confirmed the applicability of the volumetric method. Discriminant analysis seems a useful tool leading to the acquisition of a computer-aided method for the differential diagnosis of CSF resorption disorders.

Importance rating of risk factors of ischemic stroke in patients over 85 years old in the polish population.

INTRODUCTION: The European population is aging and the number of elderly patients suffering from ischemic brain stroke increases. A better knowledge of the correlation between the risk factors and the course of the disease in old people may be useful for planning medical care and prophylactic strategies. AIM: This prospective study aimed to perform a demographic and clinical analysis of the etiology of ischemic stroke, survival rate and severity of post-stroke disability in patients who developed ischemic stroke at the age of over 85 years in the Polish population. METHOD: The study group consisted of 159 patients over 85 years old with ischemic stroke. The prevalence of risk factors such as sex, hypertension, hyperlipidemia, atrial fibrillation, heart failure and diabetes was evaluated. The outcome was assessed using the Barthel scale and the National Institutes of Health Stroke Scale. RESULTS: The most common risk factors of ischemic stroke were hypertension and atrial fibrillation. Patients with atrial fibrillation had a more severe course of ischemic stroke. CONCLUSION: The course of brain stroke in the Polish population is more severe in patients over 85 years old than in younger ones. The key risk factor in this group is atrial fibrillation.

Repetitive transcranial magnetic stimulation in treatment of post polio syndrome.

BACKGROUND: Post polio syndrome is a rare disease that occurs decades after polio virus infection. Repetitive transcranial magnetic stimulation (rTMS) is a treatment option with proved effectiveness in drug resistant depression. Possibly it can be helpful in therapy of other neurological diseases including post polio syndrome. OBJECTIVE: To describe a case of patient diagnosed with post polio syndrome who was treated with rTMS stimulation with a good effect. METHODS: Patient had rTMS stimulation of left prefrontal cortex twice a week for an eight weeks. Patient's health status was evaluated before treatment, after last rTMS session and after three months from the end of the treatment. RESULTS: Improvement of fatigue score, mood disturbances and motor functions was observed after treatment. CONCLUSION: rTMS can be an effective method in treatment of post polio syndrome but further studies with larger group need to be done to confirm that data.

Polymerase chain reaction based detection of bacterial 16S rRNA gene in the cerebrospinal fluid in the diagnosis of bacterial central nervous system infection in the course of external cerebrospinal fluid drainage. Comparison with standard diagnostics currently used in clinical practice.

BACKGROUND AND PURPOSE: External drainage of cerebrospinal fluid (CSF) is a commonly used neurosurgical procedure. Complications of the procedure comprise central nervous system (CNS) bacterial infections, the frequency of which is estimated at around 6-10%. Detection of these infections is ineffective in many cases. The aim of the study was to evaluate the usefulness of a polymerase chain reaction (PCR)-based detection of bacterial 16S rRNA gene (16S rDNA) in the CSF. MATERIAL AND METHODS: The study group consisted of 50 patients. Clinical signs of CNS infection were monitored and routine laboratory and microbiological tests were performed. The results of standard methods were compared with the bacterial 16S rDNA detection. RESULTS: Using cultures, CNS infection was diagnosed in 8 patients, colonization of the drainage catheter in 6 patients, and sample contamination in 7 patients. In the group of the remaining 29 patients, no positive CSF culture was obtained and 13 of these patients also had all negative results for 16S rDNA detection. For the remaining 16 patients of this group, CNS infection, colonization of the catheter and sample contamination were diagnosed via PCR alone. Routine biochemical CSF tests and blood inflammatory parameters had a supporting value. CONCLUSIONS: Routine hospital tests do not provide rapid and efficient detection of the external drainage related bacterial CNS infection. It is justified to use several diagnostic methods simultaneously. The16S rDNA determination in CSF can increase the probability of detection of possible pathogens.

Levels of selected pro- and anti-inflammatory cytokines in cerebrospinal fluid in patients with hydrocephalus.

Cytokines are widely known mediators of inflammation accompanying many neurodegenerative disorders including normal pressure hydrocephalus (NPH). NPH is caused by impaired cerebrospinal fluid (CSF) absorption and treated by surgical shunt insertion. The early diagnosis of NPH is difficult because of various manifestations of the disease. One of the most promising research directions is biochemical CSF analysis. The aim of this study was to determine the CSF levels of cytokines. The levels of various cytokines (IL-6, IL-8, IL-12, IL-10 and TNF-α) were measured in patients with idiopathic active normal pressure hydrocephalus, arrested hydrocephalus and hydrocephalus with brain atrophy compared to controls. Our study showed that the concentrations of IL-6 and IL-8 were significantly elevated in the group with idiopathic active hydrocephalus compared to control patients. Moreover, we observed that the levels of IL-6 and IL-8 in the group with idiopathic active hydrocephalus were significantly higher compared to patients with arrested hydrocephalus and hydrocephalus with brain atrophy..

[The usefulness of the evaluation of volumetric and posturographic parameters in the differential diagnosis of hydrocephalus]. / Przydatnosc oceny parametrów posturograficznych i wolumetrycznych w diagnostyce róznicowej wodoglowia.

INTRODUCTION: A variety of diagnostic methods in normal pressure hydrocephalus and brain atrophy, it testifies to the difficulties in contrast to both teams. Develop a safe diagnostic tool having comparable statistical accuracy of the infusion test results would be of great clinical significance. The chances of implementing such a procedure in clinical practice, it may be a combination of these syndromes in the functional assessment (Posturography) the assessment of morphological CNS (volumetric). THE AIM: To evaluate and summary of the results of two non-invasive diagnostic methods morphological (posturography) and functional (volumetric) with results that were obtained from tests infusion. MATERIAL AND METHODS: The evaluation of volumetric and posturographic research was conducted in 39 patients including 27 patients with brain atrophy (BA) and in 12 patients with hydrocephalus (NPH). Volumetric measurements were made using proprietary software VisNow. Posturographic measurements performed using manual posturograph Pro-Med. RESULTS: Both the volume of CSF obtained by volumetric assessment, as well as the values of the analyzed parameters posturographic, highly correlate with the results of resistance resorption (R). The BA radius values sway with eyes open and closed R_OZ R_OO were consistent with test results infusion of 100% in the NPH radius values showed 75% compliance with the test results infusion. Volumetric parameters: the volume of CSF contained in the subarachnoid space and basal cisterns (SV) and the volume of CSF system intracranial ventricular (VV) were found in both patients NPH and BA 100% compatible resorption resistance (R). CONCLUSIONS: Simultaneous use of two non-standard methods of non-invasive (posturographic and volumetric) in the diagnostic process is a proposal to recognize normal pressure hydrocephalus and brain atrophy non-invasive methods, while maintaining very high statistical significance.

Analysis of intracranial volume ratios by means of cerebrospinal fluid deployment indicators.

INTRODUCTION: Imaging studies make it possible not only to visualize the general structure of the brain but also to take precise measurements of brain tissue volume and the size of individual lobes and their structure. The aim of this study was to determine the ratio of cerebrospinal fluid (CSF) volume contained in the intracranial ventricular system to the brain tissue volume and the ratio of CSF volume in the subarachnoid space and basal cisterns to the brain tissue volume. MATERIAL AND METHODS: The evaluation of volumetric measurements of computed tomographic (CT) images was undertaken on 23 male and female patients (average age 56.9 ± 6.1) diagnosed with normal pressure hydrocephalus (NPH) and 27 male and female patients (average age 70.6 ± 5.2) diagnosed with brain atrophy (BA). In the CT imaging studies, the total brain tissue volume and CSF volume collected in the intracranial fluid cavities were mapped to a colour scale. The VisNow software was used for volumetric evaluation. The groups were compared by means of the non-parametric Kolmogorov-Smirnov test (K-S) for independent samples. Paired data were compared by means of the nonparametric Wilcoxon test. RESULTS: The volumes of brain (brain volume - BV) and cerebrospinal fluid (fluid volume - FV) differ greatly from each other in both groups BA and NPH. The SBR (subarachnoid space and basal cisterns-to-brain ratio) and VBR (ventricle-to-brain ratio) indicators differ significantly and very much within the NPH group as well as within the BA group. In the NPH group a clearly higher value of VBR can be observed in comparison with the BA group. There was a higher value of SBR in the BA than the NPH group. CONCLUSIONS: The simultaneous use of two indicators, VBR and SBR, on a study group of 50 patients enabled the total separation of NPH and BA groups. This differentiation can have real diagnostic value. Thus the volumetric assessment of the volume of CSF and brain tissue based on CT of the head can become an important part of the differential diagnosis of hydrocephalus and brain atrophy.

[Diffusion tensor imaging (DTI) in the differential diagnosis of normal pressure hydrocephalus and brain atrophy]. / Obrazowanie tensora dyfuzji (DTI) w diagnostyce róznicowej wodoglowia normotensyjnego i zaniku mózgu.

UNLABELLED: Clinical symptomatology of idiopathic normal pressure hydrocephalus, due to its overlap with dementias and neurodegenerative brain disorders, makes diagnosis challenging. As the neurological deficits are reversible there is a need for prompt and reliable noninvasive testing. The aim was to try to use and introduction into clinical practice of new non-invasive method--diffusion tensor imaging (DTI-Diffusion Tensor Imaging) discriminating patients classified as normal pressure hydrocephalus and patients diagnosed with brain atrophy. MATERIAL AND METHODS: Using magnetic resonance-diffusion tensor imaging, we examined white matter changes within the brains of patients diagnosed with idiopathic normal pressure hydrocephalus, cerebral atrophy and controls. Diffusion tensor brain images were obtained with 3Tesla and 1.5 Tesla MR-scanners. Fractional anisotropy brain maps were generated using a computer-automated method, and tract-based spatial statistics were then applied to compare the fractional anisotropy values in the clinical groups. The fractional anisotropy data were further investigated using region-of- interest analysis set within: fibre commissural the lateral ventricles (Fclv), forceps minor of corpus callosum (Fmin), cingulum (Cg), optic radiation (Orad), superior cerebellarpeduncle (Scp), substantia nigra (nucleus ruber) (Sn). RESULTS: Compared with the cerebral atrophy or control group, the FA values in the hydrocephalus group were significantly different in the posterior cingulate (Cg) and the forceps minor of the corpus callosum (Fmin). CONCLUSION: The pattern of white matter tracts changes in select brain regions distinguishes it from cerebral atrophy and control brains. Our pilot study adds to the body of knowledge advancing the understanding of the white matter pathology of idiopathic normal- pressure hydrocephalus.

Nanofiber nets in prevention of cicatrization in spinal procedures. Experimental study.

Excessive cicatrisation or epidural fibrosis in the operative field is an inappropriate event occasionally occurring after neurosurgical procedures (i.e., spine procedures and craniotomies). This excessive process may disturb the postoperative course and render reoperations more difficult and risky. The literature describes this phenomenon as accompanying up to 20% of neurosurgical procedures. The scar tissue that forms postoperatively adheres to the dura mater, penetrates into the spinal canal and can cause narrowing symptoms, neurological deficits and pain. The incidence and spread of this excessive scar or epidural fibrosis can be prevented through the modification of the surgical technique by incorporating endoscopic or microscopic access to minimize the operative field and the use of isolating substances (autogenous or heterogeneous) administered intraoperatively. The aim of this experimental study was to morphologically assess the cicatrization process, adhesion and to prevent excessive scar formation with the local use of membranes manufactured by an electrospinning process (nanotechnology). We also investigated whether the biodegradable nanofibrous net triggers or modifies the immunological response or the local inflammatory process. Micro-nanofibrous membranes were produced by the electrospinning process. A biodegradable, medically certified copolymer poly(L-lactide-co-caprolactone) (PLCL) was used as the electrospun material. An experimental rat model was used in this study. Experimental and control groups were formed with specified follow-up times of 4, 14 and 30 days. During the operation, a two-level laminectomy in the thoracic segment was performed. The operative field was divided into two regions. Isolating material was used on the dura mater and surface of the spinal cord in the area where the laminectomy was performed. The material was analysed with the use of light and electron microscopy. Local cicatrisation can be modified using nanomaterials. Scar formation and epidural fibrosis can be limited and modified locally. No local inflammation process was observed. Initial observations indicate the potential for the effective use of materials obtained in the electrospinning process to prevent cicatrization.

Decompressive craniectomy in trauma: when to perform, what can be achieved.

SUBJECT: The goal of the study was to evaluate the effectiveness of the decompressive craniectomy (DC) concerning its various parameters. MATERIAL AND METHODS: Forty-five patients were studied (6 female, 39 male, mean age 53 years). All patients were treated because of severe traumatic brain injury. CT was performed before surgery and on the 1st to 3rd days postoperatively, and was evaluated using specific software. Parameters such as diameter of DC, volume of the additional intradural space obtained, and the shift of the midline were measured. RESULTS: In the group of patients treated with unilateral DC, the 11-cm craniectomy resulted in an average of 69 mL of additional space. The best score on the Extended Glasgow Outcome Scale (GOS-E) after DC was in patients younger than 35 years old. CONCLUSION: In our opinion DC is a suitable method of treatment for patients after severe traumatic brain injury. The best results were achieved in a group of patients aged <50 years, in particular <35 years old. DC gives extra additional space for damaged and edematous brain. DC should be performed early enough and should be large enough. Parameters of the DC obtained positive results with regard to patient status, but there are also other factors such as age and initial Glasgow Coma Scale (GCS) score, which can affect outcome.

Posturography in differential diagnosis of normal pressure hydrocephalus and brain atrophy.

Differentiation between normal pressure hydrocephalus (NPH) and brain atrophy is difficult in clinical practice. The purpose of this paper was to apply two advanced statistical, pattern recognition methods: discriminant analysis (DA) and k-nearest neighbour (K-NN) for the classification of NPH and atrophy patients to approach computer aided differential diagnosis. The classification is based on a few measures of the center of foot pressure (COP) movements (radius, area, and length). The posturography method gives a measure of current postural stability by a quantitative evaluation of postural sways. Measurements have been performed in the standing upright position in two conditions: with eyes open (EO) and closed (EC). The study comprises 18 patients (mean age 64 ±13 years) diagnosed as normal pressure hydrocephalus and qualifying for shunt implantation. The patients were evaluated by static posturography twice: before and after surgery. The NPH patients were compared with 36 atrophy patients (mean age 64±13 years) and 47 healthy persons (mean age 60 ±7 years). There were two basic dissimilarities in the NPH patients before surgery in comparison with the other groups: very large sways and their independence from vision. Over 90% of the NPH cases both before and after surgery were correctly classified. There also were over 90% of correctly classified patients if we compared the before surgery NPH and atrophy patients. Further posturographic measurements and data collection are needed to verify these results.

[Schwannoma of the common peroneal nerve. A differential diagnosis versus rare popliteal cyst]. / Nerwiak oslonkowy nerwu strzalkowego wspólnego w obrebie dolu podkolanowego. Róznicowanie z torbielami zwyrodnieniowymi.

The presented case concerns a patient with neuralgia of the common peroneal nerve and progressive neurological deficit caused by interfascicular growth of schwannoma. The ultrasound diagnostics identified the lesion as a popliteal cyst. Magnetic resonance imaging revealed features of atypical cyst location. Due to the clinical course, it was decided to decompress the nerve trunk. An interfascicular tumor was identified intraoperatively. Particular nerve bundles were separated microsurgically and the tumor of schwannoma morphology was removed. The postoperative course brought resolution of neuralgia and improvement of peroneal nerve function. In the case in question attention was focused on the differential diagnostics of processes located in the popliteal fossa. Imaging examination indicated an atypical cyst location rather than a morphologically solid tumor. The clinical course is essential for determining the nature of the lesion. Decompressing the common peroneal nerve in microsurgical technique allows the prevention of further neurological symptoms in the postoperative course.

[Occipito-cervical fixation in plasmocytoma. Method modification. Technical report]. / Stabilizacja potyliczno-szyjna u chorego w przebiegu szpiczaka. Modyfikacja metody operacyjnej. Nota techniczna.

Intraoperative modification of use and stabilization of the Axon system (Synthes) for occipito-cervical fusion in a patient treated oncologically due to plasmocytoma is presented. Pathological fracture, range of the process and damage of anterior cervical fusion necessitated the use of occipito-cervical stabilization. Different anatomical conditions within the occipital bone in the form of its thinning was observed. Fixing with screws was impossible due to the bone structure. In consequence, modification of stabilization with an ad hoc elaborated technique (burr holes in the occipital bone and stabilization with titanium wire) was implemented. Modifications and specific indications related to the clinical course of plasmocytoma are discussed.

Empyema in spinal canal in thoracic region, abscesses in paravertebral space, spondylitis: in clinical course of zoonosis Erysipelothrix rhusiopathiae.

OBJECTIVES: Erysipelas is an animal disease caused by Gram-positive bacteria Erysipelothrix rhusiopathiae. Among the domestic animals, domestic pig (Sus scrofa f. domestica) suffers most frequently from the disease in human environment. This is a typical animal-borne disease observed mainly in occupational groups employed in agriculture, farming (of animals and birds), fishing and manufacturing industry. METHODS: We are presenting the clinical course of infection (E. rhusiopathiae) and discuss clinical forms. E. rhusiopathiae in humans may have the following clinical course: mild form of skin infection diagnosed as local erythema (erysipeloid), disseminated form of skin infection and the most serious form of infection of systemic course (endocarditis and sepsis). Mild skin infection and local erythema are the most common forms. Very rare case of animal-borne infection course has been presented in which after initial phase the disease was generalised to the abscesses formation in paravertebral space, spondylitis and empyema formation in spinal canal. In the presented clinical case, the patient was suffering from diabetes. It was probably an additional risk factor of the disease generalisation. Patient underwent drainage of empyema in spinal canal, after which his neurological status gradually improved. Antibiotic therapy was implemented and continued for 8 weeks. Such course of erysipelas was not previously described in the literature. RESULTS: After therapy neurological status was improved. In follow MRI control exam empyema and spondylitis was successfully eliminated. CONCLUSIONS: Various complications of the disease, such as endocarditis and heart valves disturbances, are well known and are the most severe complications of the generalised infection. Proper targeted and long-term antibiotic therapy is crucial.

Granulomatous inflammation of dura mater--a rare side effect after application of hemostatic and insulation materials in case of two-stage operation of huge meningioma.

Haemostatic and isolating materials may cause local reactions as a foreign body. The case presented here of intracranial granulomatous lesion pertains to a patient operated in two stages due to a huge meningioma. During the first operation the tumour was partially removed. Because of persistent intraoperative haemorrhage haemostatic flakes of Oxycel and Spongostan were applied locally. In order to cover the lack of the dura, an insulation material--Tachosil was used. Histological examination of the tumour specimens confirmed the preoperative diagnosis of benign meningioma, mainly of the angiomatous subtype. The second stage of operation was performed after 3 months and the meningioma was completely removed, as well as dura mater and meningioma attachment with its oncological margin. The resected dura mater was thickened and histologically showed intensive granulomatous infiltrations and foreign body reactions most likely to Oxycel. Clinically no local and general infection and improper healing was observed after the first and the second treatment stage, but an allergic skin lesions and increased eosinophils in peripheral blood smear were noted. It was stated that systemic allergic reaction and granulomatous inflammation of dura mater were an uncommon response to the applied haemostatics and/or insulation material used during the first operation. This report show that haemostatic and isolating agents, generally used in neurosurgical procedure, may rarely cause local granulomatous processes considered as delayed hypersensitivity and the foreign body reactions. Therefore, they may hinder morphological assessment of the tissues during re-exploration and must be differentiate with the other infectious and non-infectious granulomatous processes.

Posturography in differential diagnosis of patients with enlargement of brain ventricles.

BACKGROUND AND PURPOSE: This study aimed to quantitatively evaluate balance disturbances by means of static posturography in patients with enlargement of the ventricular system (Evans ratio > 0.3). MATERIAL AND METHODS: Fifty-four patients were diagnosed and treated in our Department of Neurosurgery. Thirty-six of them were qualified as patients with brain atrophy and 18 others were identified as patients with normal pressure hydrocephalus (NPH). Average sway radius and developed area of the posturogram were evaluated with eyes open and closed. These parameters constituted a base to calculate vision indices related to radius and area as a result of division of the difference of a given parameter (radius or area) measured with eyes closed and open by its corresponding sum. RESULTS: The sway range was significantly greater in patients with NPH in comparison to the control group. In NPH, there were no differences of sways observed with eyes open or closed - the vision indices were not statistically different from zero (vision index related to radius: -6.1 ± 18.9%, vision index related to area: -5.1 ± 34.7%). This may indicate no participation of sight in postural stability control. Values of the vision index related to radius (9.3 ± 19.4%) and to area (22.1 ± 28.2%) in the atrophy group significantly differed from zero, which indicated the participation of sight in postural stability control. CONCLUSIONS: Introduction of a new measure called the 'vision index' seems to be a promising clinical practice method of differentiation of hydrocephalus and brain atrophy.

Cerebrovascular reactivity evaluated by transcranial doppler sonography in patients after aneurysmal subarachnoid haemorrhage treated with microsurgical clipping or endovascular coiling technique.

OBJECTIVE: To examine cerebrovascular reactivity in patients after subarachnoid haemorrhage (SAH) during long-term follow-up, using Acetazolamide test and transcranial Doppler (TCD) monitoring of blood flow velocities (BFVs), to compare of CO(2) reactivity between patients after SAH treated with three different methods: surgical (clipping), endovasculary (coiling) and conservative. METHODS: The study was performed in a group of 24 patients treated for SAH. Cerebrovascular reactivity (CVR) has been evaluated after intravenous administration of 1000 mg of Acetazolamide. Studied patients were divided into three groups: group I (n = 10) treated with clipping, group II (n = 8) treated with coiling and group III (n = 6)--patients with negative angiography treated conservatively. RESULTS: Results of this study have shown that: (1) BFVs were normal in cerebral arteries and did not differ between right and left head sides, (2) CVR was normal in all studied patients, (3) method of aneurysm treatment as well as its localization had no influence on BFV and CVR, and (4) occurrence of vasospasm in early days after SAH did not result in permanent disturbances of CO(2) arterial reactivity. CONCLUSION: BFV values in cerebral arteries were in normal range and did not differ on the left and right head sides. CVR was normal in all examinated patients. A method of the ruptured aneurysm treatment and its localization had no influence on CBFV and CRV. Vasospasm in early period after SAH did not provoke a persistent impairment of CO(2) reactivity.

A non-invasive assessment of intracranial volume reserve by measuring cerebrospinal fluid volume with the aid of CT imaging.

INTRODUCTION: Monitoring changes in the intracranial volume (ICV) reserve and intracranial pressure (ICP) is one of the key issues in the treatment of intracranial pathologies. The aim of this study is to develop a method of monitoring the ICV reserve by analyzing CSF volume measured using CT in specific regions. MATERIALS AND METHODS: A total of 20 patients with cerebral injury were evaluated. Analysis was performed using imaging software. On selected scans (three at the basal cistern level and three at the pineal level), the following regions were analyzed: total cerebral surface (TC1, TC2) and bilateral ambient cistern (AC) only at the basal cistern level for cerebrospinal fluid (CSF) volume. Results were correlated with patients' Glasgow Coma Scale (GCS) scores. RESULTS: An increase of CSF volume was observed with an improvement in the GCS. From the examined regions, only AC volume showed a statistically significant linear correlation (p < 0.0005) with GCS. Mean AC: 0.021, 0.454, and 0.678 mL CSF/scan in severe (3-8 pts GCS), moderate (9-12 pts GCS), and mild (13-15 pts GCS) TBI groups, respectively. DISCUSSION: Assessment of CSF volume changes in mL CSF/scan can be conducted using CT. Counting voxels corresponding to the CSF eliminates mistakes due to inaccurate region demarcation. The obtained results (AC volume) show a high correlation with patient state.