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1.
BMC Neurol ; 21(1): 26, 2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33455585

RESUMO

BACKGROUND: To investigate the feasibility of intracranial pressure (ICP) monitoring after traumatic brain injury (TBI) by electromagnetic coupling phase sensing, we established a portable electromagnetic coupling phase shift (ECPS) test system and conducted a comparison with invasive ICP. METHODS: TBI rabbits' model were all synchronously monitored for 24 h by ECPS testing and invasive ICP. We investigated the abilities of the ECPS to detect targeted ICP by feature extraction and traditional classification decision algorithms. RESULTS: The ECPS showed an overall downward trend with a variation range of - 13.370 ± 2.245° as ICP rose from 11.450 ± 0.510 mmHg to 38.750 ± 4.064 mmHg, but its change rate gradually declined. It was greater than 1.5°/h during the first 6 h, then decreased to 0.5°/h and finally reached the minimum of 0.14°/h. Nonlinear regression analysis results illustrated that both the ECPS and its change rate decrease with increasing ICP post-TBI. When used as a recognition feature, the ability (area under the receiver operating characteristic curve, AUCs) of the ECPS to detect ICP ≥ 20 mmHg was 0.88 ± 0.01 based on the optimized adaptive boosting model, reaching the advanced level of current noninvasive ICP assessment methods. CONCLUSIONS: The ECPS has the potential to be used for noninvasive continuous monitoring of elevated ICP post-TBI.


Assuntos
Algoritmos , Lesões Encefálicas Traumáticas/complicações , Hipertensão Intracraniana/diagnóstico , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Animais , Fenômenos Eletromagnéticos , Hipertensão Intracraniana/etiologia , Masculino , Coelhos
3.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732262

RESUMO

OBJECTIVES: Acute nystagmus (AN) is an uncommon neurologic sign in children presenting to pediatric emergency departments. We described the epidemiology, clinical features, and underlying causes of AN in a large cohort of children, aiming at identifying features associated with higher risk of severe underlying urgent conditions (UCs). METHODS: Clinical records of all patients aged 0 to 18 years presenting for AN to the pediatric emergency departments of 9 Italian hospitals in an 8-year period were retrospectively reviewed. Clinical and demographic features and the underlying causes were analyzed. A logistic regression model was applied to detect predictive variables associated with a higher risk of UCs. RESULTS: A total of 206 patients with AN were included (male-to-female ratio: 1.01; mean age: 8 years 11 months). The most frequently associated symptoms were headache (43.2%) and vertigo (42.2%). Ataxia (17.5%) and strabismus (13.1%) were the most common neurologic signs. Migraine (25.7%) and vestibular disorders (14.1%) were the most common causes of AN. Idiopathic infantile nystagmus was the most common cause in infants <1 year of age. UCs accounted for 18.9% of all cases, mostly represented by brain tumors (8.3%). Accordant with the logistic model, cranial nerve deficits, ataxia, or strabismus were strongly associated with an underlying UC. Presence of vertigo or attribution of a nonurgent triage code was associated with a reduced risk of UCs. CONCLUSIONS: AN should be considered an alarming finding in children given the risk of severe UCs. Cranial nerve palsy, ataxia, and strabismus should be considered red flags during the assessment of a child with AN.


Assuntos
Nistagmo Patológico/etiologia , Ataxia/complicações , Ataxia/diagnóstico , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Infecções do Sistema Nervoso Central/complicações , Infecções do Sistema Nervoso Central/diagnóstico , Criança , Pré-Escolar , Estudos de Coortes , Doenças dos Nervos Cranianos/complicações , Doenças dos Nervos Cranianos/diagnóstico , Doenças Desmielinizantes/complicações , Doenças Desmielinizantes/diagnóstico , Tontura/etiologia , Serviço Hospitalar de Emergência , Feminino , Cefaleia/etiologia , Humanos , Hipertensão Intracraniana/complicações , Hipertensão Intracraniana/diagnóstico , Itália , Masculino , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico , Náusea/etiologia , Envenenamento/complicações , Envenenamento/diagnóstico , Estudos Retrospectivos , Estrabismo/etiologia , Vertigem/etiologia , Doenças Vestibulares/complicações , Doenças Vestibulares/diagnóstico , Vômito/etiologia
4.
BMC Neurol ; 20(1): 268, 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631262

RESUMO

BACKGROUND: The ultrasound based non-invasive ICP measurement method has been recently validated. Correlation of symptoms and signs of intracranial hypertension with actual ICP measurements in patients with large intracranial tumors is controversial. The purpose of this study was to assess ICP in patients with brain tumors, presenting with neurological signs and symptoms of elevated ICP and to further evaluate the value and utility of non-invasive ICP monitoring. METHODS: Twenty patients underwent non-invasive ICP measurement using a two-depth transcranial Doppler ultrasound designed to simultaneously compare pulse dynamics in the proximal (intracranial), and the distal (extracranial) intraorbital segments of the ophthalmic artery through the closed eyelid. RESULTS: Forty-eight measurements were analyzed. Radiological characteristics included tumor volume (range = 5.45-220.27cm3, mean = 48.81 cm3), perilesional edema (range = 0-238.27cm3, mean = 74.40 cm3), and midline shift (mean = 3.99 mm). All ICP measurements were in the normal range of 7-16 mmHg (ICPmean: 9.19 mmHg). The correlation of demographics, clinical and radiological variables in a bivariate association, showed a statistically significant correlation with neurological deficits and ICPmax (p = 0.02) as well as ICPmean (p = 0.01). The correlation between ICP and neurological deficits, showed a negative value of the estimate. The ICP was not increased in all cases, whether ipsilateral nor contralateral to the tumor. The multivariate model analysis demonstrated that neurological deficits were associated with lower ICPmax values, whereas maximum tumor diameter was associated with larger ICPmax values. CONCLUSIONS: This study demonstrated that ICP in patients with intracranial tumors and mass effect is not necessarily increased. Therefore, clinical signs of intracranial hypertension do not necessarily reflect increased ICP.


Assuntos
Neoplasias Encefálicas/complicações , Hipertensão Intracraniana/diagnóstico , Ultrassonografia Doppler Transcraniana/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pressão Intracraniana , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Artéria Oftálmica/fisiopatologia , Projetos Piloto
5.
J Clin Neurosci ; 76: 171-176, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32331944

RESUMO

The aim of the current study was to assess the risk factors, clinical symptoms and Cerebrospinal fluid (CSF) pressure of idiopathic intracranial hypertension (IIH) with emphasis on determining the risk factors which involved in poor response to treatment. We retrospectively included 202 patients who were diagnosed with IIH. Disease severity was classified according to prescribed therapeutic option into 4 groups: acetazolamide (group 1), Acetazolamide plus topiramate or Lasix (group 2), repeated LP (group 3) and surgical intervention (group 4). Being in the higher group was considered as a higher severity of disease and poor response to treatment. Among the evaluated features of IIH, the strongest association were observed between opening CSF pressure and disease severity. So that, the highest CSF pressure was observed in patients who underwent surgery, which represent the highest severity of disease (group 4) and poor response to therapy (mean ± SD: 43.9 ± 21.1 cm H2O). Headache was the most prevalent symptom of IIH in our series which was significantly higher among acetazolamide group. Blurred vision was the second most common symptoms which, unlike the headache was more reported in surgery group. Our results suggested that higher CSF pressure could be the risk factors of poor response to therapy, which may raise need for more intensive treatment. Furthermore, suffering of headache without blurred vision can consider as a prognostic factor for mild severity and good response to treatment.


Assuntos
Pressão do Líquido Cefalorraquidiano/fisiologia , Hipertensão Intracraniana/terapia , Acetazolamida/uso terapêutico , Adulto , Anticonvulsivantes/uso terapêutico , Diuréticos/uso terapêutico , Feminino , Cefaleia/etiologia , Humanos , Hipertensão Intracraniana/diagnóstico , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Topiramato/uso terapêutico , Resultado do Tratamento , Transtornos da Visão/etiologia
6.
Curr Neurol Neurosci Rep ; 20(4): 8, 2020 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-32219578

RESUMO

PURPOSE OF REVIEW: The goal of this review is to describe the presenting features of fulminant idiopathic intracranial hypertension (IIH) and outline the multimodal approach to its treatment. RECENT FINDINGS: Venous sinus stenting may be an appropriate alternative to optic nerve sheath fenestration or cerebrospinal fluid shunting in select patients with fulminant IIH. Prompt surgical intervention maximizes the chance of visual recovery in patients with fulminant IIH. "Fulminant IIH" is defined as intracranial hypertension with no secondary cause, severe vision loss within 4 weeks of symptom onset, and progressive vision loss over days. Rapid recognition of the fulminant phenotype of IIH by emergency department physicians, neurologists, and ophthalmologists is critical. Without appropriate triage and rapid medical and surgical intervention, patients with fulminant IIH are at high risk for profound, permanent vision loss. Prompt surgical intervention with optic nerve sheath fenestration, cerebrospinal fluid shunting, or venous sinus stenting minimizes the chance of poor visual outcome. If a delay is anticipated, serial lumbar punctures or temporary cerebrospinal fluid drainage and medical therapy may forestall irreversible vision loss.


Assuntos
Hipertensão Intracraniana/diagnóstico , Hipertensão Intracraniana/terapia , Procedimentos Neurocirúrgicos/métodos , Derivação Ventriculoperitoneal/métodos , Humanos , Hipertensão Intracraniana/epidemiologia , Pseudotumor Cerebral/diagnóstico , Pseudotumor Cerebral/epidemiologia , Pseudotumor Cerebral/terapia , Transtornos da Visão/diagnóstico , Transtornos da Visão/epidemiologia , Transtornos da Visão/terapia
7.
Medicina (Kaunas) ; 56(2)2020 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-32093047

RESUMO

BACKGROUND AND OBJECTIVES: Bedside sonographic duplex technique (SDT) may be used as an adjunct to cranial computed tomography (CCT) to monitor brain-injured patients after decompressive craniectomy (DC). The present study aimed to assess the value of SDT in repeated measurements of ventricle dimensions in patients after DC by comparing both techniques. MATERIALS AND METHODS: Retrospective assessment of 20 consecutive patients after DC for refractory intracranial pressure (ICP) increase following subarachnoid hemorrhage (SAH), bleeding and trauma which were examined by SDT and CCT in the context of routine clinical practice. Whenever a repeated CCT was clinically indicated SDT examinations were performed within 24 hours and correlated via measurement of the dimensions of all four cerebral ventricles. Basal cerebral arteries including pathologies such as vasospasms were also evaluated in comparison to selected digital subtraction angiography (DSA). RESULTS: Repeated measurements of all four ventricle diameters showed high correlation between CCT and SDT (right lateral r = 0.997, p < 0.001; left lateral r = 0.997, p < 0.001; third r = 0.991, p < 0.001, fourth ventricle r = 0.977, p < 0.001). SDT performed well in visualizing basal cerebral arteries including pathologies (e.g., vasospasms) as compared to DSA. CONCLUSIONS: Repeated SDT measurements of the dimensions of all four ventricles in patients after DC for refractory ICP increase delivered reproducible results comparable to CCT. SDT may be considered as a valuable bedside monitoring tool in patients after DC.


Assuntos
Craniectomia Descompressiva/métodos , Hipertensão Intracraniana/etiologia , Monitorização Fisiológica/normas , Sistemas Automatizados de Assistência Junto ao Leito/tendências , Ultrassonografia Doppler Dupla/métodos , Adulto , Idoso , Feminino , Humanos , Hipertensão Intracraniana/diagnóstico , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Monitorização Fisiológica/estatística & dados numéricos , Estudos Retrospectivos
8.
Dev Med Child Neurol ; 62(7): 799-805, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32060907

RESUMO

AIM: To evaluate the impact of risk factors for intracranial hypertension (ICH) on cerebral cortex thickness in syndromic craniosynostosis. METHOD: ICH risk factors including papilloedema, hydrocephalus, obstructive sleep apnea (OSA), cerebellar tonsillar position, occipitofrontal circumference (OFC) curve deflection, age, and sex were collected from the records of patients with syndromic craniosynostosis (Apert, Crouzon, Pfeiffer, Muenke, Saethre-Chotzen syndromes) and imaging. Magnetic resonance images were analysed and exported for statistical analysis. A linear mixed model was developed to determine correlations with cerebral cortex thickness changes. RESULTS: In total, 171 scans from 107 patients (83 males, 88 females [including repeated scans], mean age 8y 10mo, range 1y 1mo-34y, SD 5y 9mo) were evaluated. Mean cortical thickness in this cohort was 2.78mm (SD 0.17). Previous findings of papilloedema (p=0.036) and of hydrocephalus (p=0.007) were independently associated with cortical thinning. Cortical thickness did not vary significantly by sex (p=0.534), syndrome (p=0.896), OSA (p=0.464), OFC (p=0.375), or tonsillar position (p=0.682). INTERPRETATION: Detection of papilloedema or hydrocephalus in syndromic craniosynostosis is associated with significant changes in cortical thickness, supporting the need for preventative rather than reactive treatment strategies. WHAT THIS PAPER ADDS: Papilloedema is associated with thinning of the cerebral cortex in syndromic craniosynostosis, independently of hydrocephalus.


Assuntos
Córtex Cerebral/patologia , Craniossinostoses/diagnóstico , Hidrocefalia/diagnóstico , Hipertensão Intracraniana/diagnóstico , Papiledema/diagnóstico , Adolescente , Adulto , Córtex Cerebral/diagnóstico por imagem , Criança , Pré-Escolar , Craniossinostoses/diagnóstico por imagem , Craniossinostoses/patologia , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/patologia , Lactente , Hipertensão Intracraniana/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Papiledema/diagnóstico por imagem , Papiledema/patologia , Fatores de Risco , Síndrome , Adulto Jovem
9.
World Neurosurg ; 137: 94-97, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32006734

RESUMO

BACKGROUND: Elevation of bone for the treatment of depressed skull fractures overlying venous sinuses is rarely required or performed. The neurosurgical literature only describes a handful of cases of surgical intervention in which the posterior two-thirds of the superior sagittal sinus was involved. Clinical course is variable, signs and symptoms suggest increased intracranial pressure, and all conservative measures should be exhausted before proceeding with the surgical route. CASE DESCRIPTION: A 27-year-old man presented with a self-inflicted gunshot wound to posterior head. On presentation, there were no neurologic complaints. On imaging, the bullet fragment was associated with a comminuted anteriorly displaced fracture over the torcula. Vessel imaging showed tapering of the superior sagittal sinus and transverse sinuses near the torcula, suggesting narrowing due to mass effect. The patient did not respond to initial conservative management and developed worsening diplopia and papilledema concerning for increased intracranial pressure. Occipital/suboccipital craniectomy was performed with elevation of depressed skull fracture, decompression of dural venous sinus, removal of bullet, and mesh cranioplasty. Repeat ophthalmology examination postoperatively showed improvement in optic disc edema and diplopia. CONSLUSIONS: This case confirms that the approach of surgical management of superior sagittal venous sinus injuries associated with skull fractures described in the literature also can be used successfully for injuries over the torcula if conservative management does not help alleviate the symptoms and results in good outcome. It was felt that delayed surgery also plays an important role, as it gives time for scar tissue to form, which may help to protect the sinus from injury during surgery.


Assuntos
Cavidades Cranianas/cirurgia , Hipertensão Intracraniana/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Adulto , Cavidades Cranianas/lesões , Humanos , Hipertensão Intracraniana/diagnóstico , Hipertensão Intracraniana/etiologia , Masculino , Papiledema/diagnóstico , Papiledema/cirurgia , Fraturas Cranianas/complicações , Fraturas Cranianas/cirurgia , Seio Sagital Superior/cirurgia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/diagnóstico
10.
Eur J Radiol ; 125: 108875, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32105916

RESUMO

PURPOSE: To evaluate the correlation between optic nerve sheath diameter (ONSD) measurement with signs of increased intracranial pressure (ICP) found on computed tomography (CT) in trauma patients. MATERIALS AND METHODS: 271 consecutive head CT trauma scans performed at our trauma center were retrospectively reviewed for ONSD and CT findings. Measurement of ONSD was made at CT and, when available, with ultrasonography (US). Imaging signs of increased ICP were assessed. Association between ONSD and signs of ICP were analyzed. RESULTS: The mean ONSD on axial CT images, optic-nerve axial plane and US was 4.70 ± 0.59 mm, 4.78 ± 0.59 mm, and 3.16 ± 0.50 mm, respectively. The ONSD measured at CT was significantly higher than that measured by US(p < 0.01). No difference of ONSD measured at CT between axial and optic-nerve axial planes. Patients with CT evidence of increased ICP had significantly higher ONSD than those without imaging abnormalities (p = 0.0001-0.0064). The ONSD cutoff points for suggesting increased ICP were 4.8 mm (60.5 % sensitivity, 61.2 % specificity, 20.4 % PPV, 90.4 % NPV) at CT and 3.15 mm (97.4 % sensitivity, 13.8 % specificity, 15.7 % PPV, 97 % NPV) at US. CONCLUSION: There was a significant association between ONSD and imaging signs of increased ICP in CT with a high NPV. No difference of ONSD measurement at CT between normal and optic-nerve axial planes was observed, whereas there was a significant difference between diameter obtained at CT and US.


Assuntos
Lesões Encefálicas/complicações , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/fisiopatologia , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/fisiopatologia , Feminino , Humanos , Hipertensão Intracraniana/diagnóstico , Pressão Intracraniana/fisiologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
12.
World Neurosurg ; 136: e535-e541, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31954892

RESUMO

BACKGROUND: Severe traumatic brain injury (TBI) remains a major cause of morbidity and mortality with mortality rates reaching 35%. Intracranial pressure (ICP) monitoring is used to prevent secondary brain injury and death. However, while the association of elevated ICP and worsened outcomes is accepted, routine ICP monitoring has been questioned after the publication of several studies including the Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure trial. We examined whether severe TBI patients in the trauma system of Pennsylvania fared better with or without ICP monitoring. METHODS: We conducted a statewide retrospective analysis and included all TBI patients >18 years with an admission Glasgow Coma Scale (GCS) <9 from January 2000 through December 2017. The primary outcome was mortality. Secondary outcomes examined were intensive care unit length of stay (LOS) and discharge functional independence measure (FIM). RESULTS: A total of 36,929 patients matched our inclusion criteria and were included in the analysis. Of those, 6025 (16.3%) had ICP monitor placement. Mean ICU LOS was significantly higher in ICP-monitored patients (13.1 ± 11.6 days vs. 6.0 ± 10.8 days, P < 0.0001). Increasing age was a significant predictor of death (P < 0.0001). Mean FIM scores at discharge were significantly higher in patients without an ICP monitor (16.21 ± 4.91 vs. 9.53 ± 5.07, P < 0.0001). When controlling for injury severity score, GCS, age, and craniotomy, ICP monitoring conferred a hazard ratio of 0.85 (χ2 = 32.63, P < 0.0001), a 25% reduction of in-hospital mortality compared with non-ICP-monitored patients. CONCLUSION: We found that ICP-monitored patients had a lower risk of in-hospital mortality. Our findings support the use of ICP monitors in eligible patients.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Hipertensão Intracraniana/diagnóstico , Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/reabilitação , Feminino , Humanos , Hipertensão Intracraniana/mortalidade , Pressão Intracraniana/fisiologia , Estimativa de Kaplan-Meier , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Pennsylvania/epidemiologia , Estudos Retrospectivos , Centros de Traumatologia
14.
Int J Pediatr Otorhinolaryngol ; 131: 109856, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31918246

RESUMO

OBJECTIVE: We aimed to evaluate the effect of an increase in intracranial pressure (ICP) due to sympatho-adrenergic response caused by mouth gag and tongue depressor during adenotonsillectomy by measuring the optic nerve sheath diameter (ONSD) by ultrasonographic method. METHODS: Forty patients (age range 3-12 years) who underwent adenotonsillectomy were included in the study. All patients underwent surgery under general anesthesia with endotracheal intubation. Boyle-Davis mouth gag was used during the procedure. ONSD measurement was performed and a high-frequency linear probe. All ONSD measurements were performed by a single investigator experienced in the use of ultrasound. Ultrasonographically measured ONSD before induction was accepted as baseline (T0) value. Immediately after insertion of the mouth gag (T1), just before removal of the mouth gag (T2), and just before extubation (T3), ultrasonographic measurements of ONSD were recorded. RESULTS: When patients' baseline ONSD values were compared with the values obtained in T1, T2, T3, and a statistically significant increase was detected. The ONSD value measured before removing the mouth gag (T2) was significantly higher than the ONSD value measured immediately after the insertion of the mouth gag (T1). The ONSD value measured just before extubation (T3) and after removal of the mouth gag was significantly lower than the ONSD value (T2) measured just before removal of the mouth gag. When heart rate, mean arterial pressure (MAP), peripheral oxygen saturation (SpO2) values of T0, T1, T2, T3 were compared, any statistically significant difference was not observed. When end-tidal carbon dioxide level (etCO2) and peak inspiratory pressure (PIP) values of T1, T2, T3 were compared, any statistically significant difference was not observed. CONCLUSION: This study showed that the Boyle-Davis mouth gag used during the adenotonsillectomy operation resulted in a significant increase in the diameter of the optic nerve sheath measured ultrasonographically and increased the ONSD even further during the time the mouth gag was remained in situ. In children with intracranial pathologies who will undergo adenotonsillectomy or those with increased ICP-related risk factors, the risks that may arise from the effect of the Boyle-Davis mouth gag on ICP should be considered.


Assuntos
Adenoidectomia/efeitos adversos , Hipertensão Intracraniana/etiologia , Nervo Óptico/anatomia & histologia , Tonsilectomia/efeitos adversos , Adenoidectomia/instrumentação , Adenoidectomia/métodos , Anestesia Geral , Pressão Sanguínea , Dióxido de Carbono/análise , Criança , Pré-Escolar , Feminino , Frequência Cardíaca , Humanos , Hipertensão Intracraniana/diagnóstico , Pressão Intracraniana , Masculino , Boca , Bainha de Mielina , Nervo Óptico/diagnóstico por imagem , Estudos Prospectivos , Tonsilectomia/instrumentação , Tonsilectomia/métodos , Ultrassonografia
15.
Pediatr Crit Care Med ; 21(3): 240-247, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31569184

RESUMO

OBJECTIVES: Electroencephalography is used in neurocritical care for detection of seizures and assessment of cortical function. Due to limited resolution from scalp electroencephalography, important abnormalities may not be readily detectable. We aimed to identify whether intracranial electroencephalography allows for improved methods of monitoring cortical function in children with severe traumatic brain injury. DESIGN: This is a retrospective cohort study from a prospectively collected clinical database. We investigated the occurrence rate of epileptiform abnormalities detected on intracranial electroencephalography when compared with scalp electroencephalography. We also investigated the strength of association of quantitative electroencephalographic parameters and cerebral perfusion pressure between both intracranial and scalp electroencephalography. SETTING: This is a single-institution study performed in the Phoenix Children's Hospital PICU. PATIENTS: Eleven children with severe traumatic brain injury requiring invasive neuromonitoring underwent implantation of a six-contact intracranial electrode as well as continuous surface electroencephalography. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Visual detection of epileptiform abnormalities was performed by pediatric epileptologists. Association of intracranial and scalp electroencephalography total power, alpha percentage, and alpha-delta power ratio to cerebral perfusion pressure was performed using univariate dynamic structural equations modeling. Demographic data were assessed by retrospective analysis. Intracranial and scalp electroencephalography was performed in 11 children. Three of 11 children had observed epileptiform abnormalities on intracranial electroencephalography. Two patients had epileptiform abnormalities identified exclusively on intracranial electroencephalography, and one patient had seizures initiating on intracranial electroencephalography before arising on scalp electroencephalography. Identification of epileptiform abnormalities was associated with subsequent identification of stroke or malignant cerebral edema. We observed statistically significant positive associations between intracranial alpha-delta power ratio to cerebral perfusion pressure in nine of 11 patients with increased strength of association on intracranial compared with scalp recordings. CONCLUSIONS: These findings suggest that intracranial electroencephalography may be useful for detection of secondary insult development in children with traumatic brain injury.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Eletroencefalografia/métodos , Monitorização Neurofisiológica/métodos , Adolescente , Arizona , Encéfalo/fisiopatologia , Circulação Cerebrovascular , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Hipertensão Intracraniana/diagnóstico , Hipertensão Intracraniana/epidemiologia , Pressão Intracraniana , Masculino , Estudos Retrospectivos , Convulsões/diagnóstico , Convulsões/epidemiologia
16.
World Neurosurg ; 133: e105-e114, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31479786

RESUMO

BACKGROUND: For patients with TBI, traditional methods such as clinical examination and imaging data are the primary references used for deciding whether to operate or not. Intracranial pressure (ICP) monitoring based on lateral ventricles or parenchymal pressure is a more direct reflection of ICP. However, the research on whether the outcome results of ICP monitoring are better than results based on clinical signs and imaging is sparse. Therefore, we compared treatment results for patients with TBI based on ICP monitoring and traditional methods. METHODS: This retrospective study included patients with TBI admitted to our collaborative hospitals between January 1, 2012, and December 31, 2013. All patients enrolled were divided into a traditional methods group and ICP monitoring group. Follow-up treatment was determined by ICP monitoring value or traditional methods in the 2 groups. Propensity matching scores were used to ensure that baseline characteristics of patients in the 2 groups were consistent. RESULTS: A significant association was found between the initial ICP value and neurologic deterioration (odds ratio 1.24; P < 0.001), and nonlinear correlation achieved the best fit (R2 = 0.547). Both 6-month good recovery rate and favorable outcome rate were higher in the ICP monitoring group than the traditional methods group by propensity score analysis (P < 0.05). CONCLUSIONS: For patients with TBI with cerebral contusion volume >20 mL, both 6-month good recovery rate and favorable outcome rate were significantly higher in the ICP monitoring group than the traditional methods group.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Hipertensão Intracraniana/etiologia , Pressão Intracraniana , Monitorização Fisiológica , Adulto , Idoso , Lesões Encefálicas Traumáticas/terapia , Cuidados Críticos , Feminino , Escala de Coma de Glasgow , Humanos , Hipertensão Intracraniana/diagnóstico , Hipertensão Intracraniana/cirurgia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
17.
World Neurosurg ; 133: e18-e25, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31394360

RESUMO

BACKGROUND: Intracranial pressure monitoring remains the foundation for prevention of secondary injury after traumatic brain injury and is most commonly performed using an external ventricular drain or intraparenchymal pressure monitor. The Integra Flex ventricular catheter combines an external ventricular catheter with a pressure transducer embedded in the tip of the catheter to allow continuous pressure readings while simultaneously draining cerebrospinal fluid. Discrepancies between measurements from the continuously reported internal pressure transducer and intermittently assessed and externally transduced ventricular drain prompted an analysis and characterization of pressures transduced from the same ventricular source. METHODS: More than 500 hours of high-resolution (125 Hz) continuous recordings were manually reviewed to identify 73 hours of simultaneous measurements (clamped external ventricular drain) from internal and external transducers in patients with traumatic brain injury. RESULTS: A significant positive bias was found in pressure readings obtained from external relative to internal measurements. The 2 methods of measurement generally correlated poorly with each other and variably. Although proportional bias was found with Bland-Altman analysis, coherence revealed rare shifts in the external transducer as a major source of discrepancy. Infrequent changes in the 0-level of the external transducer were found to be the primary source of discrepancy. Relative to the observed differences, no significant trend was observed over time between the 2 modalities. CONCLUSIONS: This study suggests that the internal pressure transducer may be a more reliable estimate of intracranial pressure relative to bedside external transducers due to the inherent behavioral requirement of leveling.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Erros de Diagnóstico , Drenagem/instrumentação , Hipertensão Intracraniana/diagnóstico , Pressão Intracraniana , Manometria/instrumentação , Transdutores de Pressão , Lesões Encefálicas Traumáticas/complicações , Cateteres , Humanos , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/prevenção & controle , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Transdutores de Pressão/classificação
18.
BMJ Case Rep ; 12(11)2019 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-31748372

RESUMO

Use of medications including vitamin A derivatives and tetracyclines have been associated with papilledema and raised intracranial pressure. A 46-year-old woman was referred to neuro-ophthalmology for bilateral optic disc oedema and had a 7-year history of cyclosporine use after renal transplantation. She had preserved visual function and moderate bilateral optic disc oedema. Magnetic resonance imaging and magnetic resonance venography of the brain were normal apart from signs of raised intracranial pressure. Lumbar puncture revealed an elevated opening pressure of 40 cm of water with normal cerebrospinal fluid contents. Nephrology was consulted and cyclosporine was switched to tacrolimus and she was treated with acetazolamide. The papilledema resolved within 1 month of her initial visit. It is important to recognise the role that cyclosporine plays in raising intracranial pressure, especially in patients requiring immunosuppression, such as transplant patients. Tacrolimus is a suitable alternative in these cases.


Assuntos
Ciclosporina/efeitos adversos , Imunossupressores/efeitos adversos , Hipertensão Intracraniana/induzido quimicamente , Papiledema/induzido quimicamente , Papiledema/tratamento farmacológico , Acetazolamida/uso terapêutico , Ciclosporina/uso terapêutico , Diagnóstico Diferencial , Diuréticos/uso terapêutico , Feminino , Humanos , Imunossupressores/uso terapêutico , Hipertensão Intracraniana/diagnóstico , Pressão Intracraniana/efeitos dos fármacos , Transplante de Rim/efeitos adversos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Papiledema/diagnóstico por imagem , Punção Espinal/métodos , Tacrolimo/uso terapêutico , Resultado do Tratamento
19.
Ann Intern Med ; 171(12): 896-905, 2019 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-31739316

RESUMO

Background: Optic nerve ultrasonography (optic nerve sheath diameter sonography) has been proposed as a noninvasive, quick method for diagnosing increased intracranial pressure. Purpose: To examine the accuracy of optic nerve ultrasonography for diagnosing increased intracranial pressure in children and adults. Data Sources: 13 databases from inception through May 2019, reference lists, and meeting proceedings. Study Selection: Prospective optic nerve ultrasonography diagnostic accuracy studies, published in any language, involving any age group or reference standard. Data Extraction: 3 reviewers independently abstracted data and performed quality assessment. Data Synthesis: Of 71 eligible studies involving 4551 patients, 61 included adults, and 35 were rated as having low risk of bias. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of optic nerve ultrasonography in patients with traumatic brain injury were 97% (95% CI, 92% to 99%), 86% (CI, 74% to 93%), 6.93 (CI, 3.55 to 13.54), and 0.04 (CI, 0.02 to 0.10), respectively. Respective estimates in patients with nontraumatic brain injury were 92% (CI, 86% to 96%), 86% (CI, 77% to 92%), 6.39 (CI, 3.77 to 10.84), and 0.09 (CI, 0.05 to 0.17). Accuracy estimates were similar among studies stratified by patient age, operator specialty and training level, reference standard, sonographer blinding status, and cutoff value. The optimal cutoff for optic nerve sheath dilatation on ultrasonography was 5.0 mm. Limitation: Small studies, imprecise summary estimates, possible publication bias, and no evaluation of effect on clinical outcomes. Conclusion: Optic nerve ultrasonography can help diagnose increased intracranial pressure. A normal sheath diameter measurement has high sensitivity and a low negative likelihood ratio that may rule out increased intracranial pressure, whereas an elevated measurement, characterized by a high specificity and positive likelihood ratio, may indicate increased intracranial pressure and the need for additional confirmatory tests. Primary Funding Source: None. (PROSPERO: CRD42017055485).


Assuntos
Hipertensão Intracraniana/diagnóstico por imagem , Nervo Óptico/diagnóstico por imagem , Testes Imediatos , Ultrassonografia , Adulto , Lesões Encefálicas/complicações , Lesões Encefálicas/diagnóstico por imagem , Criança , Interpretação Estatística de Dados , Humanos , Hipertensão Intracraniana/diagnóstico , Hipertensão Intracraniana/etiologia , Pressão Intracraniana , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Ultrassonografia/métodos
20.
Intensive Care Med ; 45(12): 1783-1794, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31659383

RESUMO

BACKGROUND: Management algorithms for adult severe traumatic brain injury (sTBI) were omitted in later editions of the Brain Trauma Foundation's sTBI Management Guidelines, as they were not evidence-based. METHODS: We used a Delphi-method-based consensus approach to address management of sTBI patients undergoing intracranial pressure (ICP) monitoring. Forty-two experienced, clinically active sTBI specialists from six continents comprised the panel. Eight surveys iterated queries and comments. An in-person meeting included whole- and small-group discussions and blinded voting. Consensus required 80% agreement. We developed heatmaps based on a traffic-light model where panelists' decision tendencies were the focus of recommendations. RESULTS: We provide comprehensive algorithms for ICP-monitor-based adult sTBI management. Consensus established 18 interventions as fundamental and ten treatments not to be used. We provide a three-tier algorithm for treating elevated ICP. Treatments within a tier are considered empirically equivalent. Higher tiers involve higher risk therapies. Tiers 1, 2, and 3 include 10, 4, and 3 interventions, respectively. We include inter-tier considerations, and recommendations for critical neuroworsening to assist the recognition and treatment of declining patients. Novel elements include guidance for autoregulation-based ICP treatment based on MAP Challenge results, and two heatmaps to guide (1) ICP-monitor removal and (2) consideration of sedation holidays for neurological examination. CONCLUSIONS: Our modern and comprehensive sTBI-management protocol is designed to assist clinicians managing sTBI patients monitored with ICP-monitors alone. Consensus-based (class III evidence), it provides management recommendations based on combined expert opinion. It reflects neither a standard-of-care nor a substitute for thoughtful individualized management.


Assuntos
Algoritmos , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/fisiopatologia , Hipertensão Intracraniana/diagnóstico , Hipertensão Intracraniana/fisiopatologia , Monitorização Fisiológica/normas , Guias de Prática Clínica como Assunto , Adulto , Idoso , Idoso de 80 Anos ou mais , Conferências de Consenso como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos
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