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1.
Medicine (Baltimore) ; 99(35): e21655, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871879

RESUMO

BACKGROUND: To compare the effects of 3% hypertonic saline solution and 20% mannitol solution on intracranial hypertension. METHODS: WAN-FANGDATA, CNKI, and CQVIP databases were searched, and relevant literatures of randomized controlled trials comparing 3% hypertonic saline solution with mannitol in reducing intracranial hypertension from 2010 to October 2019 were collected. Meta-analysis was performed using RevMan software. RESULTS: As a result, 10 articles that met the inclusion criteria were finally included. A total of 544 patients were enrolled in the study, 270 in the hypertonic saline group and 274 in the mannitol group. There was no significant difference in the decrease of intracranial pressure and the onset time of drug between the 2 groups after intervention (all P > .05). There was a statistically significant difference between the hypertonic saline group and the mannitol group in terms of duration of effect in reducing intracranial pressure (95% confidence interval: 0.64-1.05, Z = 8.09, P < .00001) and cerebral perfusion pressure after intervention (95% confidence interval: 0.15-0.92, Z = 2.72, P = .007). CONCLUSION: Both 3% hypertonic saline and mannitol can effectively reduce intracranial pressure, but 3% hypertonic saline has a more sustained effect on intracranial pressure and can effectively increase cerebral perfusion pressure.


Assuntos
Lesões Encefálicas Traumáticas/tratamento farmacológico , Diuréticos Osmóticos/uso terapêutico , Hipertensão Intracraniana/tratamento farmacológico , Manitol/uso terapêutico , Solução Salina Hipertônica/uso terapêutico , Lesões Encefálicas Traumáticas/complicações , Diuréticos Osmóticos/farmacologia , Humanos , Hipertensão Intracraniana/etiologia , Pressão Intracraniana/efeitos dos fármacos , Manitol/farmacologia , Solução Salina Hipertônica/farmacologia
2.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32868470

RESUMO

Pediatric care providers, pediatricians, pediatric subspecialty physicians, and other health care providers should be able to recognize children with abnormal head shapes that occur as a result of both synostotic and deformational processes. The purpose of this clinical report is to review the characteristic head shape changes, as well as secondary craniofacial characteristics, that occur in the setting of the various primary craniosynostoses and deformations. As an introduction, the physiology and genetics of skull growth as well as the pathophysiology underlying craniosynostosis are reviewed. This is followed by a description of each type of primary craniosynostosis (metopic, unicoronal, bicoronal, sagittal, lambdoid, and frontosphenoidal) and their resultant head shape changes, with an emphasis on differentiating conditions that require surgical correction from those (bathrocephaly, deformational plagiocephaly/brachycephaly, and neonatal intensive care unit-associated skill deformation, known as NICUcephaly) that do not. The report ends with a brief discussion of microcephaly as it relates to craniosynostosis as well as fontanelle closure. The intent is to improve pediatric care providers' recognition and timely referral for craniosynostosis and their differentiation of synostotic from deformational and other nonoperative head shape changes.


Assuntos
Craniossinostoses/diagnóstico , Acrocefalossindactilia/genética , Fenótipo de Síndrome de Antley-Bixler/genética , Suturas Cranianas/anatomia & histologia , Disostose Craniofacial , Craniossinostoses/classificação , Craniossinostoses/etiologia , Craniossinostoses/cirurgia , Cabeça/anormalidades , Humanos , Lactente , Hipertensão Intracraniana/etiologia , Ilustração Médica , Microcefalia/etiologia , Osteogênese/fisiologia , Fenótipo , Fotografação , Polidactilia/genética , Receptores de Fatores de Crescimento de Fibroblastos/metabolismo , Procedimentos Cirúrgicos Reconstrutivos , Crânio/anatomia & histologia , Crânio/diagnóstico por imagem , Crânio/crescimento & desenvolvimento , Sinostose/complicações , Sinostose/diagnóstico por imagem
3.
Medicine (Baltimore) ; 99(38): e22004, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957318

RESUMO

BACKGROUND: Mannitol and hypertonic saline (HTS) are effective in reducing intracranial pressure (ICP) after severe traumatic brain injury (TBI). However, their efficacy on the ICP has not been evaluated rigorously. OBJECTIVE: To evaluate the efficacy of repeated bolus dosing of HTS and mannitol in similar osmotic burdens to treat intracranial hypertension (ICH) in patients with severe TBI. METHODS: The authors used an alternating treatment protocol to evaluate the efficacy of HTS with that of mannitol given for ICH episodes in patients treated for severe TBI at their hospital during 2017 to 2019. Doses of similar osmotic burdens (20% mannitol, 2 ml/kg, or 10% HTS, 0.63 ml/kg, administered as a bolus via a central venous catheter, infused over 15 minutes) were given alternately to the individual patient with severe TBI during ICH episodes. The choice of osmotic agents for the treatment of the initial ICH episode was determined on a randomized basis; osmotic agents were alternated for every subsequent ICH episode in each individual patient. intracranial pressure (ICP), mean arterial pressure (MAP), and cerebral perfusion pressure (CPP) were continuously monitored between the beginning of each osmotherapy and the return of ICP to 20 mm Hg. The duration of the effect of ICP reduction (between the beginning of osmotherapy and the return of ICP to 20 mm Hg), the maximum reduction of ICP and its time was recorded after each dose. Serum sodium and plasma osmolality were measured before, 0.5 hours and 3 hours after each dose. Adverse effects such as central pontine myelinolysis (CPM), severe fluctuations of serum sodium and plasma osmolality were assessed to evaluate the safety of repeated dosing of HTS and mannitol. RESULTS: Eighty three patients with severe TBI were assessed, including 437 ICH episodes, receiving 236 doses of HTS and 221 doses of mannitol totally. There was no significant difference between equimolar HTS and mannitol boluses on the magnitude of ICP reduction, the duration of effect, and the time to lowest ICP achieved (P > .05). The proportion of efficacious boluses was higher for HTS than for mannitol (P = .016), as was the increase in serum sodium (P = .038). The serum osmolality increased immediately after osmotherapy with a significant difference (P = .017). No cases of CPM were detected. CONCLUSION: Repeat bolus dosing of 10% HTS and 20% mannitol appears to be significantly and similarly effective for treating ICH in patients with severe TBI. The proportion of efficacious doses of HTS on ICP reduction may be higher than mannitol.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Diuréticos Osmóticos/uso terapêutico , Hipertensão Intracraniana/tratamento farmacológico , Hipertensão Intracraniana/etiologia , Manitol/uso terapêutico , Solução Salina Hipertônica/uso terapêutico , Adulto , Circulação Cerebrovascular/efeitos dos fármacos , Diuréticos Osmóticos/administração & dosagem , Diuréticos Osmóticos/efeitos adversos , Feminino , Humanos , Pressão Intracraniana/efeitos dos fármacos , Masculino , Manitol/administração & dosagem , Manitol/efeitos adversos , Pessoa de Meia-Idade , Solução Salina Hipertônica/administração & dosagem , Solução Salina Hipertônica/efeitos adversos , Índices de Gravidade do Trauma
4.
Acta Clin Croat ; 59(1): 50-54, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32724274

RESUMO

Optic nerve sheath diameter (ONSD) enlargement is detectable in traumatic brain injury patients with raised intracranial pressure (ICP). The aim was to assess its value in neurological patients suspected to have increased ICP. Patient clinical imaging data and hospitalization outcome were analyzed. Patients were divided into groups according to brain pathology and level of consciousness with Glasgow Coma Score (GCS). Poor hospitalization outcome was assessed by modified Rankin scale (mRS) >3. Data obtained by ocular sonography performed in acute setting were compared with data of 100 control subjects. Data were expressed as mean ± SD. Intergroup comparison was performed by Student's t-test. Data of 34 patients (63+16 years) were suitable for analysis, including 8 primary intracerebral hemorrhage (PICH), 8 subarachnoid hemorrhage (SAH), 12 PICH or SAH and intraventricular hemorrhage (IVH), 4 tumors and 2 ischemic strokes. The mean ONSD was 5.86+0.69 mm in patients versus 4.38+0.41 mm in controls (p<0.01). ONSD was 6.28+0.61 mm in patients with GCS <8 and 5.77+0.55 mm in other patients (p<0.05). ONSD was 5.72+0.59 mm in PICH versus 6.20+0.65 mm in PICH/SAH with IVH (p=0.1). ONSD was 5.73+0.38 mm in SAH in comparison to PICH/SAH with IVH (p=0.05). There was no statistically significant difference in optic nerve diameter between patients and controls (2.48+0.28 mm vs. 2.39+0.33 mm; p>0.05). Pronounced enlargement of ONSD was observed in patients with ICH or SAH with IVH, and in patients with GCS <8. Enlarged ONSD was associated with poor neurological outcome (mRS >3).


Assuntos
Hipertensão Intracraniana , Pressão Intracraniana , Nervo Óptico , Idoso , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva , Hipertensão Intracraniana/diagnóstico por imagem , Hipertensão Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade , Nervo Óptico/diagnóstico por imagem , Ultrassonografia
5.
Stud Health Technol Inform ; 271: 184-190, 2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32578562

RESUMO

BACKGROUND: Intracranial hypertension is a serious complication in the intensive care of children with severe traumatic brain injury (STBI). OBJECTIVE: The goal was to create a computer system for simultaneous neuromonitoring of cerebral parameters and Arden-Syntax-based clinical decision support (CDS) in children with STBI undergoing intensive care treatment. METHODS: Intensive care of these patients is based on internationally accepted guidelines. Arden Syntax, which is an HL7 medical knowledge representation and processing standard for CDS systems, was used to develop digital algorithms for these guidelines. RESULTS: Comparison of a group of 37 conventionally treated patients with a second group (84 patients) monitored and treated with the combined CDS system yielded statistically significant differences. CONCLUSION: A combination of cerebral autoregulation monitoring with Arden-Syntax-based CDS in accordance with guidelines for the treatment of intracranial hypertension in children with STBI provides markedly better treatment outcomes. It opens up new options for the use of standards to formalize and process medical knowledge in neuromonitoring.


Assuntos
Lesões Encefálicas Traumáticas , Sistemas de Apoio a Decisões Clínicas , Hipertensão Intracraniana , Inteligência Artificial , Lesões Encefálicas Traumáticas/complicações , Criança , Homeostase , Humanos , Hipertensão Intracraniana/etiologia
7.
Neurotox Res ; 38(1): 1-7, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-244976

RESUMO

As a severe and highly contagious infectious disease, coronavirus disease 2019 (COVID-19) has caused a global pandemic. Several case reports have demonstrated that the respiratory system is the main target in patients with COVID-19, but the disease is not limited to the respiratory system. Case analysis indicated that the nervous system can be invaded by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and that 36.4% of COVID-19 patients had neurological symptoms. Importantly, the involvement of the CNS may be associated with poor prognosis and disease worsening. Here, we discussed the symptoms and evidence of nervous system involvement (directly and indirectly) caused by SARS-CoV-2 infection and possible mechanisms. CNS symptoms could be a potential indicator of poor prognosis; therefore, the prevention and treatment of CNS symptoms are also crucial for the recovery of COVID-19 patients.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Doenças do Sistema Nervoso/etiologia , Pneumonia Viral/complicações , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/etiologia , Terapia Combinada , Transtornos da Consciência/epidemiologia , Transtornos da Consciência/etiologia , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/virologia , Tontura/epidemiologia , Tontura/etiologia , Encefalite Viral/epidemiologia , Encefalite Viral/etiologia , Células Endoteliais/metabolismo , Células Endoteliais/virologia , Fadiga/epidemiologia , Fadiga/etiologia , Cefaleia/epidemiologia , Cefaleia/etiologia , Humanos , Hipertensão Intracraniana/epidemiologia , Hipertensão Intracraniana/etiologia , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Transtornos Mentais/terapia , Transtornos do Humor/tratamento farmacológico , Transtornos do Humor/epidemiologia , Transtornos do Humor/etiologia , Transtornos do Humor/terapia , Doenças do Sistema Nervoso/epidemiologia , Neurônios/metabolismo , Neurônios/virologia , Nervo Olfatório/virologia , Pandemias , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/psicologia , Pneumonia Viral/virologia , Prevalência , Prognóstico , Psicoterapia , Psicotrópicos/uso terapêutico , Receptores Virais/metabolismo , Estudos Retrospectivos , Transtornos das Sensações/epidemiologia , Transtornos das Sensações/etiologia , Glicoproteína da Espícula de Coronavírus/metabolismo
9.
Am J Trop Med Hyg ; 103(2): 723-726, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32431278

RESUMO

Meningoencephalitis is not a rare disease in small children. However, eosinophilic meningitis due to Angiostrongylus cantonensis is unusual in a baby. We describe the case of a 9-month-old baby from North Vietnam with eosinophilic meningoencephalitis. The baby lived in a rural area, where farming is widespread, and presented with fever and seizures. Laboratory results showed peripheral eosinophilia (16.1%), cerebrospinal fluid (CSF) white blood cell count 220/mm3 (26% eosinophils), CSF antibody test positive for Ascaris, CSF ELISA positive for Angiostrongylus cantonensis, and blood ELISA positive for A. cantonensis. A mobile worm was identified in the CSF. The presentation was consistent with a diagnosis of A. cantonensis eosinophilic meningitis. The baby recovered fully after administering albendazole (200 mg/day for 2 weeks), and intravenous dexamethasone (0.6 mg/kg/day every 8 hours) and mannitol (1.5 g/kg/day every 8 hours) for the first 3 days, followed by 5 days of oral prednisolone (2 mg/kg/day).


Assuntos
Angiostrongylus cantonensis/isolamento & purificação , Eosinofilia/sangue , Meningoencefalite/fisiopatologia , Infecções por Strongylida/fisiopatologia , Albendazol/uso terapêutico , Animais , Anti-Helmínticos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Anticorpos Anti-Helmínticos/sangue , Anticorpos Anti-Helmínticos/líquido cefalorraquidiano , Dexametasona/uso terapêutico , Diuréticos Osmóticos/uso terapêutico , Eosinofilia/etiologia , Humanos , Lactente , Hipertensão Intracraniana/tratamento farmacológico , Hipertensão Intracraniana/etiologia , Imagem por Ressonância Magnética , Masculino , Manitol/uso terapêutico , Meningoencefalite/complicações , Meningoencefalite/tratamento farmacológico , Meningoencefalite/metabolismo , Prednisolona/uso terapêutico , Convulsões/etiologia , Convulsões/fisiopatologia , Infecções por Strongylida/complicações , Infecções por Strongylida/tratamento farmacológico , Infecções por Strongylida/metabolismo , Tomografia Computadorizada por Raios X , Vietnã
11.
Neurotox Res ; 38(1): 1-7, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32399719

RESUMO

As a severe and highly contagious infectious disease, coronavirus disease 2019 (COVID-19) has caused a global pandemic. Several case reports have demonstrated that the respiratory system is the main target in patients with COVID-19, but the disease is not limited to the respiratory system. Case analysis indicated that the nervous system can be invaded by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and that 36.4% of COVID-19 patients had neurological symptoms. Importantly, the involvement of the CNS may be associated with poor prognosis and disease worsening. Here, we discussed the symptoms and evidence of nervous system involvement (directly and indirectly) caused by SARS-CoV-2 infection and possible mechanisms. CNS symptoms could be a potential indicator of poor prognosis; therefore, the prevention and treatment of CNS symptoms are also crucial for the recovery of COVID-19 patients.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Doenças do Sistema Nervoso/etiologia , Pneumonia Viral/complicações , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/etiologia , Terapia Combinada , Transtornos da Consciência/epidemiologia , Transtornos da Consciência/etiologia , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/virologia , Tontura/epidemiologia , Tontura/etiologia , Encefalite Viral/epidemiologia , Encefalite Viral/etiologia , Células Endoteliais/metabolismo , Células Endoteliais/virologia , Fadiga/epidemiologia , Fadiga/etiologia , Cefaleia/epidemiologia , Cefaleia/etiologia , Humanos , Hipertensão Intracraniana/epidemiologia , Hipertensão Intracraniana/etiologia , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Transtornos Mentais/terapia , Transtornos do Humor/tratamento farmacológico , Transtornos do Humor/epidemiologia , Transtornos do Humor/etiologia , Transtornos do Humor/terapia , Doenças do Sistema Nervoso/epidemiologia , Neurônios/metabolismo , Neurônios/virologia , Nervo Olfatório/virologia , Pandemias , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/psicologia , Pneumonia Viral/virologia , Prevalência , Prognóstico , Psicoterapia , Psicotrópicos/uso terapêutico , Receptores Virais/metabolismo , Estudos Retrospectivos , Transtornos das Sensações/epidemiologia , Transtornos das Sensações/etiologia , Glicoproteína da Espícula de Coronavírus/metabolismo
12.
Cerebrovasc Dis ; 49(2): 160-169, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32316014

RESUMO

OBJECTIVE: This study aimed to control blood pressure (BP) under transcranial Doppler (TCD) guidance in patients with anterior circulation acute ischemic stroke after endovascular treatment (EVT) to reduce the incidence of early neurological deterioration (END) and improve neurological prognosis. METHODS: This prospective randomized controlled study included 95 patients who were randomly divided into a TCD-guided BP control (TBC) group and a non-TCD-guided BP control (NBC) group. The patients were monitored by TCD within 72 h after EVT. In the TBC group, BP decreased, BP increased, or intracranial pressure decreased when TCD showed blood flow acceleration, deceleration, or intracranial hypertension respectively. The BP of the NBC group was controlled according to the guidelines. The incidence of END and the prognosis was compared between the 2 groups. RESULTS: TCD identified 18 patients with blood flow acceleration, but the prognosis of the 2 groups was not significantly different. TCD identified 23 patients with blood flow deceleration, and the poor prognosis rate at discharge was lower in the TBC group than in the NBC group (45.5 vs. 91.7%, p = 0.027). TCD identified 34 patients with intracranial hypertension, and the 3-month mortality rate of the TBC group was lower than that of the NBC group (0 vs. 36.8%, p = 0.011). The incidence rates of END and 3-month mortality in the TBC group were lower than those in the NBC group (13.8 vs. 37.5%, p = 0.036; 0 vs. 25.0%, p = 0.012) when TCD parameters were abnormal. Multivariable logistic regression analysis showed that the TBC group (adjusted OR 0.267, 95% CI 0.074-0.955; p = 0.042) was an independent protective factor against the incidence of END when TCD parameters were abnormal. CONCLUSION: These findings indicated that TCD-guided BP and intracranial pressure control improved the prognosis of patients with blood flow deceleration and intracranial hypertension.


Assuntos
Pressão Sanguínea , Isquemia Encefálica/terapia , Procedimentos Endovasculares/efeitos adversos , Hipertensão Intracraniana/diagnóstico por imagem , Pressão Intracraniana , Acidente Vascular Cerebral/terapia , Ultrassonografia Doppler Transcraniana , Idoso , Pequim , Velocidade do Fluxo Sanguíneo , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/mortalidade , Isquemia Encefálica/fisiopatologia , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/mortalidade , Hipertensão Intracraniana/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
13.
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
14.
J Neurol Surg A Cent Eur Neurosurg ; 81(4): 324-329, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32176924

RESUMO

OBJECTIVE: To present our experience in the diagnosis and management protocol of 13 patients with a depressed skull fracture over the superior sagittal sinus (SSS) who developed delayed neurologic deterioration. PATIENTS AND METHODS: This retrospective study was conducted in the Neurosurgical Department, Assiut University Hospitals, between May 2012 and May 2017. All patients with a depressed skull fracture over the SSS were reviewed. Only those patients who were neurologically intact after trauma but suffered delayed neurologic deterioration were included in this study. Preoperative characteristics of age, sex, cause of trauma, type and site of the depressed skull fracture, and clinical presentation were reviewed and evaluated. Neuroimaging including brain computed tomography and computed tomography venography were evaluated. RESULTS: Of 612 patients with depressed skull fractures admitted to our department, 63 had the fracture segment on the SSS. Thirteen patients, nine males and four females, met the inclusion criteria (age range: 5-42 years). The most common cause of trauma was assault from others (seven patients). Eight patients had a compound depressed fracture; the other five fractures were simple. Interval between trauma and neurologic deterioration ranged between 4 days and 3 weeks. Clinical deterioration included decrease of consciousness, headache, blurred vision, and repeated vomiting. Deterioration of consciousness was seen in four patients. Eight patients had sixth cranial nerve palsy. Visual deterioration was seen in four patients. All the included patients were operated on for elevation of the depressed segment. Eleven patients improved; two patients who presented initially with visual deterioration did not improve. Their visual deterioration persisted after surgery. For both these patients, lumbar puncture revealed high cerebrospinal fluid (CSF) pressure. Clinical improvement followed the insertion of a thecoperitoneal shunt. CONCLUSION: Increased intracranial pressure (ICP) may follow a depressed fracture over the SSS. It may occur immediately after trauma or later. Surgical decompression with elevation of the depressed segment is indicated. Persistence of manifestations of raised ICP despite elevation of the depressed segment indicates the occurrence of an SSS thrombosis. CSF pressure should be measured to confirm the diagnosis and consider a thecoperitoneal shunt.


Assuntos
Hipertensão Intracraniana/etiologia , Fratura do Crânio com Afundamento/cirurgia , Seio Sagital Superior/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Angiografia por Tomografia Computadorizada , Descompressão Cirúrgica , Feminino , Humanos , Hipertensão Intracraniana/diagnóstico por imagem , Hipertensão Intracraniana/cirurgia , Masculino , Estudos Retrospectivos , Fratura do Crânio com Afundamento/complicações , Fratura do Crânio com Afundamento/diagnóstico por imagem , Seio Sagital Superior/diagnóstico por imagem , Seio Sagital Superior/fisiopatologia , Adulto Jovem
15.
World Neurosurg ; 138: 344-348, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32217173

RESUMO

BACKGROUND: Patients with single-suture or minor suture craniosynostosis are typically asymptomatic at early presentation; intervention is aimed at reducing the risk of elevated intracranial pressure and associated developmental sequelae. Patients may be symptomatic in cases of major multisuture syndromic synostoses or delayed diagnosis. Clinical presentation in this context may include headaches, papilledema, cognitive delay, or behavioral issues. Cranial nerve palsies are atypical symptoms of intracranial hypertension in this patient population. CASE DESCRIPTION: An 11-month-old, otherwise healthy girl presented with bilateral severe papilledema and left abducens nerve palsy owing to nonsyndromic near-complete bilateral squamosal suture synostosis with associated incomplete sagittal and right lambdoid synostoses. The patient underwent urgent open cranial expansion, with resolution of her papilledema and improvement in eye position and motility. CONCLUSIONS: Cranial nerve palsies may be presenting symptoms of intracranial hypertension in patients with craniosynostosis. Multidisciplinary evaluation and treatment is paramount for appropriate management.


Assuntos
Doenças do Nervo Abducente/etiologia , Craniossinostoses/complicações , Craniossinostoses/cirurgia , Papiledema/etiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Feminino , Humanos , Lactente , Hipertensão Intracraniana/etiologia , Crânio/cirurgia
16.
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
17.
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
18.
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
19.
World Neurosurg ; 137: e430-e436, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32035212

RESUMO

BACKGROUND: Decompressive craniectomy (DC) is a widely used treatment for refractory high intracranial pressure (ICP). While the Brain Trauma Foundation guidelines favor large DC, there remains a lack of consensus regarding the optimal size of DC in relationship to the patient's head size. The aim of this study is to determine the optimal size of DC to effectively control refractory ICP in traumatic brain injury and to measure that size with a method that takes into consideration the patient's head size. METHODS: All cases of unilateral DC performed to control refractory increased ICP due to cerebral edema during a 7½-year period were included. Demographic and injury-related data were collected by retrospective chart review. The patients were categorized in 2 groups: 21 patients with a "small flaps" and 9 patients with a "large flap." RESULTS: Two groups had similar preoperative characteristics. The amount of cerebrospinal fluid drained and the doses of hyperosmolar therapy given were not different between the 2 groups. The postoperative ICP was significantly lower for the large craniectomy flap group: 13.3 mm Hg confidence interval 99% [12.7, 13.8] versus 16.9 mm Hg confidence interval 99% [16.5, 17.2] (P = 0.01), and this difference was maintained for 96 hours postoperatively. CONCLUSIONS: Better ICP control was achieved in patients who underwent a large decompressive craniectomy (ratio >65%) when compared with smaller craniectomy sizes. The proposed method of measuring the craniectomy size, to our knowledge, is the first to take into account the patient's head size and can be easily measured intraoperatively.


Assuntos
Edema Encefálico/cirurgia , Lesões Encefálicas Traumáticas/cirurgia , Craniectomia Descompressiva/métodos , Cabeça/anatomia & histologia , Hipertensão Intracraniana/cirurgia , Retalhos Cirúrgicos , Adolescente , Adulto , Edema Encefálico/etiologia , Lesões Encefálicas Traumáticas/complicações , Feminino , Humanos , Hipertensão Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
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