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1.
Acta Neurochir (Wien) ; 166(1): 287, 2024 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-38980542

RESUMO

BACKGROUND: Bacterial meningitis can cause a life-threatening increase in intracranial pressure (ICP). ICP-targeted treatment including an ICP monitoring device and external ventricular drainage (EVD) may improve outcomes but is also associated with the risk of complications. The frequency of use and complications related to ICP monitoring devices and EVDs among patients with bacterial meningitis remain unknown. We aimed to investigate the use of ICP monitoring devices and EVDs in patients with bacterial meningitis including frequency of increased ICP, drainage of cerebrospinal fluid (CSF), and complications associated with the insertion of ICP monitoring and external ventricular drain (EVD) in patients with bacterial meningitis. METHOD: In a single-center prospective cohort study (2017-2021), we examined the frequency of use and complications of ICP-monitoring devices and EVDs in adult patients with bacterial meningitis. RESULTS: We identified 108 patients with bacterial meningitis admitted during the study period. Of these, 60 were admitted to the intensive care unit (ICU), and 47 received an intracranial device (only ICP monitoring device N = 16; EVD N = 31). An ICP > 20 mmHg was observed in 8 patients at insertion, and in 21 patients (44%) at any time in the ICU. Cerebrospinal fluid (CSF) was drained in 24 cases (51%). Severe complications (intracranial hemorrhage) related to the device occurred in two patients, but one had a relative contraindication to receiving a device. CONCLUSIONS: Approximately half of the patients with bacterial meningitis needed intensive care and 47 had an intracranial device inserted. While some had conservatively correctable ICP, the majority needed CSF drainage. However, two patients experienced serious adverse events related to the device, potentially contributing to death. Our study highlights that the incremental value of ICP measurement and EVD in managing of bacterial meningitis requires further research.


Assuntos
Cuidados Críticos , Drenagem , Pressão Intracraniana , Meningites Bacterianas , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Pressão Intracraniana/fisiologia , Drenagem/métodos , Drenagem/efeitos adversos , Adulto , Idoso , Estudos Prospectivos , Cuidados Críticos/métodos , Estudos de Coortes , Monitorização Fisiológica/métodos , Hipertensão Intracraniana/cirurgia , Ventriculostomia/métodos , Ventriculostomia/efeitos adversos
2.
Radiology ; 312(1): e240114, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38980182

RESUMO

Background Discrepancies in the literature regarding optimal optic nerve sheath diameter (ONSD) cutoffs for intracranial pressure (ICP) necessitate alternative neuroimaging parameters to improve clinical management. Purpose To evaluate the diagnostic accuracy of the dimensions of the perineural subarachnoid space to the optic nerve sheath ratio, measured using US, in predicting increased ICP. Materials and Methods In a prospective cohort study from April 2022 to December 2023, patients with suspected increased ICP underwent optic nerve US to determine the dimensions of arachnoid bulk (DAB) ratio and ONSD before invasive ICP measurement. Correlation between the parameters and ICP, as well as diagnostic accuracy, was assessed using area under the receiver operating characteristic curve (AUC) analysis. Results A total of 30 participants were included (mean age, 39 years ± 14 [SD]; 24 female). The DAB ratio and ONSD were significantly larger in participants with increased ICP (38% [0.16 of 0.42] and 14% [0.82 of 6.04 mm], respectively; P < .001). The DAB ratio showed a stronger correlation with ICP than ONSD (rs = 0.87 [P < .001] vs rs = 0.61 [P < .001]). The DAB ratio and ONSD optimal cutoffs for increased ICP were 0.5 and 6.5 mm, respectively, and the ratio had higher sensitivity (100% vs 92%) and specificity (94% vs 83%) compared with ONSD. Moreover, the DAB ratio better predicted increased ICP than ONSD, with a higher AUC (0.98 [95% CI: 0.95, 1.00] vs 0.86 [95% CI: 0.71, 0.95], P = .047). Conclusion An imaging ratio was proposed to predict ICP based on the relative anatomy of the cerebrospinal fluid space, demonstrating more accurate diagnosis of increased ICP and a strong correlation with ICP values, suggesting its potential utility as a neuroimaging marker in clinical settings. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Shepherd in this issue.


Assuntos
Aracnoide-Máter , Hipertensão Intracraniana , Pressão Intracraniana , Nervo Óptico , Humanos , Feminino , Masculino , Adulto , Estudos Prospectivos , Nervo Óptico/diagnóstico por imagem , Pressão Intracraniana/fisiologia , Hipertensão Intracraniana/diagnóstico por imagem , Hipertensão Intracraniana/fisiopatologia , Aracnoide-Máter/diagnóstico por imagem , Ultrassonografia/métodos , Pessoa de Meia-Idade
3.
Pediatr Emerg Med Pract ; 21(Suppl 6): 1-48, 2024 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-38885364

RESUMO

More than 1.7 million traumatic brain injuries occur in adults and children each year in the United States, with approximately 30% occurring in children aged <14 years. Traumatic brain injury is a significant cause of morbidity and mortality in pediatric trauma patients. The early management of severe traumatic brain injury is focused on mitigation and prevention of secondary injury, specifically by avoiding hypotension and hypoxia, which have been associated with poorer outcomes. This review discusses methods to maintain adequate oxygenation, maximize management of intracranial hypertension, and optimize blood pressure in the emergency department to improve neurologic outcomes following pediatric severe traumatic brain injury.


Assuntos
Lesões Encefálicas Traumáticas , Serviço Hospitalar de Emergência , Humanos , Lesões Encefálicas Traumáticas/terapia , Lesões Encefálicas Traumáticas/diagnóstico , Criança , Adolescente , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/terapia , Hipertensão Intracraniana/diagnóstico , Pré-Escolar , Lactente , Medicina Baseada em Evidências
4.
BMC Neurol ; 24(1): 203, 2024 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-38877431

RESUMO

BACKGROUND: We present a rare case of NeuroBehcet's-related intracranial hypertension without cerebral venous thrombosis (NBrIHwCVT), occurring as the first presentation of NeuroBehcet's. In addition, we describe the novel use of subcutaneous tocilizumab for this indication. This is followed by a review of the literature on this topic. CASE: The patient was a 28-year-old lady of Southern Chinese origin with a known history of Behcet's disease with oral ulcers and ocular findings for which she was on mycophenolate mofetil and adalimumab. She presented with a headache and bilateral disc swelling associated with an intracranial pressure (ICP) of > 40cmH20. There were no structural lesions or cerebral venous thrombosis (CVT) on imaging. Initial lumbar puncture had raised leucocytes and protein. We discuss diagnostic challenges given persistently elevated ICP despite subsequent non-inflammatory cerebrospinal fluid (CSF) profiles and non-response to acetazolamide. She eventually showed a response to immunosuppressant therapy in the form of pulsed methylprednisolone, cyclophosphamide and subsequently subcutaneous tocilizumab, supporting the diagnosis of NBrIHwCVT. Complete normalization of ICP remains challenging. Her disease course was severe, unusual for her ethnicity. LITERATURE REVIEW: We identified 34 patients (including ours) from 14 publications. We found that the majority of NBrIHwCVT patients were young (average age of 34 years), with a slight female preponderance. Of the 17 cases in the literature with available data on CSF profile, none had raised leucocytes whilst one patient had elevated protein. Patients were generally treated with steroids and occasionally azathioprine, in line with the suspected autoimmune pathophysiology. Of 22 patients with data on outcome, six (27%) were noted to have recurrence of symptoms generally occurring a few months later. CONCLUSION: As demonstrated by this case, NBrIHwCVT can present with BD with raised ICP even if there is no prior history of NB, central Asian ethnicity, cerebral venous thrombosis or features of inflammation on the CSF. We demonstrated how novel use of Tocilizumab may have a role in the management of NBrIHwCVT. Based on our literature review, patients were more likely to be young, female, display a non-inflammatory CSF picture, be treated with steroids and harbour a possibility of recurrence.


Assuntos
Síndrome de Behçet , Hipertensão Intracraniana , Humanos , Feminino , Adulto , Síndrome de Behçet/complicações , Síndrome de Behçet/tratamento farmacológico , Anticorpos Monoclonais Humanizados/uso terapêutico , Imunossupressores/uso terapêutico
5.
Sci Rep ; 14(1): 14535, 2024 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-38914585

RESUMO

The rapid perfusion of cerebral arteries leads to a significant increase in intracranial blood volume, exposing patients with traumatic brain injury to the risk of diffuse brain swelling or malignant brain herniation during decompressive craniectomy. The microcirculation and venous system are also involved in this process, but the precise mechanisms remain unclear. A physiological model of extremely high intracranial pressure was created in rats. This development triggered the TNF-α/NF-κB/iNOS axis in microglia, and released many inflammatory factors and reactive oxygen species/reactive nitrogen species, generating an excessive amount of peroxynitrite. Subsequently, the capillary wall cells especially pericytes exhibited severe degeneration and injury, the blood-brain barrier was disrupted, and a large number of blood cells were deposited within the microcirculation, resulting in a significant delay in the recovery of the microcirculation and venous blood flow compared to arterial flow, and this still persisted after decompressive craniectomy. Infliximab is a monoclonal antibody bound to TNF-α that effectively reduces the activity of TNF-α/NF-κB/iNOS axis. Treatment with Infliximab resulted in downregulation of inflammatory and oxidative-nitrative stress related factors, attenuation of capillary wall cells injury, and relative reduction of capillary hemostasis. These improved the delay in recovery of microcirculation and venous blood flow.


Assuntos
Hipertensão Intracraniana , Estresse Oxidativo , Animais , Ratos , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/tratamento farmacológico , Masculino , Fator de Necrose Tumoral alfa/metabolismo , Inflamação/metabolismo , Inflamação/patologia , Microcirculação , Circulação Cerebrovascular , Ratos Sprague-Dawley , Lesões Encefálicas Traumáticas/metabolismo , Lesões Encefálicas Traumáticas/patologia , Infliximab/farmacologia , Infliximab/uso terapêutico , Modelos Animais de Doenças , Barreira Hematoencefálica/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Espécies Reativas de Nitrogênio/metabolismo , Microglia/metabolismo
6.
BMJ Paediatr Open ; 8(1)2024 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-38942587

RESUMO

BACKGROUND: Raised intracranial pressure (ICP) contributes to approximately 20% of the admissions in the paediatric intensive care unit (PICU) in our setting. Timely identification and treatment of raised ICP is important to prevent brain herniation and death in such cases. The objective of this study was to examine the role of optic nerve sheath diameter (ONSD) in detecting clinically relevant raised ICP in children. METHODS: A hospital-based observational analytical study in a PICU of a tertiary care institute in India on children aged 2-14 years. ONSD was measured in all children on three time points that is, day 1, day 2 and between day 4 and 7 of admission. ONSD values were compared between children with and without clinical signs of raised ICP. RESULTS: Out of 137 paediatric patients recruited, 34 had signs of raised ICP. Mean ONSD on day 1 was higher in children with signs of raised ICP (4.99±0.57 vs 4.06±0.40; p<0.01). Mean ONSD on day 2 also was higher in raised ICP patients (4.94±0.55 vs 4.04±0.40; p<0.01). The third reading between days 4 and 7 of admission was less than the first 2 values but still higher in raised ICP patients (4.48±1.26 vs 3.99±0.57; p<0.001). The cut-off ONSD value for detecting raised ICP was 4.46 mm on the ROC curve with an area under curve 0.906 (95% CI 0.844 to 0.968), 85.3% sensitivity and 86.4% specificity. There was no difference in ONSD between the right and the left eyes at any time point irrespective of signs of raised ICP. CONCLUSION: We found that measurement of ONSD by transorbital ultrasound was able to detect clinically relevant raised ICP with an excellent discriminatory performance at the cut-off value of 4.46 mm.


Assuntos
Hipertensão Intracraniana , Nervo Óptico , Humanos , Criança , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/patologia , Hipertensão Intracraniana/diagnóstico , Hipertensão Intracraniana/diagnóstico por imagem , Pré-Escolar , Feminino , Masculino , Adolescente , Unidades de Terapia Intensiva Pediátrica , Índia , Ultrassonografia/métodos , Pressão Intracraniana/fisiologia , Curva ROC , Sensibilidade e Especificidade
8.
Clin Neurol Neurosurg ; 242: 108310, 2024 07.
Artigo em Inglês | MEDLINE | ID: mdl-38788542

RESUMO

BACKGROUND: Gold standard for determining intracranial pressure (ICP), intraventricular catheter, is invasive with associated risks. Non-invasive investigations like magnetic resonance imaging and ultrasonography have demonstrated correlation between optic nerve sheath diameter (ONSD) and raised ICP. However, computed tomography (CT) is accessible and less operator-dependent. Literature shows variable results regarding correlations between ICP and ONSD on CT. The study aimed to investigate correlations between raised ICP and ONSD, eyeball transverse diameter (ETD), and ONSD/ETD ratios on CT scan(s) of severe head injuries. METHODS: A retrospective review of a three-year prospectively-maintained database of severe traumatic head injuries in patients who had ICP measurements and CT scans was conducted. Glasgow Coma Score (GCS), ICP, ONSD 3 mm and 9 mm behind the globe, ETD, ONSD/ETD ratios, CT Marshall Grade, and Glasgow Outcome Score (GOS) were recorded. Statistical analysis assessed correlations between ICP and CT measurements. RESULTS: Seventy-four patients were assessed; mortality rate: 36.5 %. Assault (48.6 %) and pedestrian-vehicle collisions (21.6 %) were the most common mechanisms. CT Marshall Grade correlated significantly with 3 mm and 9 mm ONSD, ONSD/ETD ratios, GCS, and GCS motor score, which correlated significantly with GOS. No significant correlation was found between ICP and ONSD, ETD or ONSD/ETD ratios. Marshall Grade was not significantly associated with ICP measurements but correlated with injury severity. CONCLUSIONS: Unlike previous studies, our study not only investigated the correlation between ICP and single variables (ONSD and ETD) but also the ONSD/ETD ratios. No correlations were observed between raised ICP and ONSD, ETD or ONSD/ETD ratio on CT in neurotrauma patients.


Assuntos
Traumatismos Craniocerebrais , Pressão Intracraniana , Nervo Óptico , Tomografia Computadorizada por Raios X , Humanos , Masculino , Feminino , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/patologia , Pressão Intracraniana/fisiologia , Adulto , Pessoa de Meia-Idade , Estudos Retrospectivos , Traumatismos Craniocerebrais/diagnóstico por imagem , Idoso , Adulto Jovem , Adolescente , Escala de Coma de Glasgow , Hipertensão Intracraniana/diagnóstico por imagem , Hipertensão Intracraniana/etiologia , Olho/diagnóstico por imagem , Idoso de 80 Anos ou mais
9.
World Neurosurg ; 187: e656-e664, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38704142

RESUMO

OBJECTIVE: The measurement of optic nerve sheath diameter is a noninvasive, practical, and economical method used to identify increased intracranial pressure. The purpose of this study is to detect the preoperative and postoperative changes in optic nerve sheath diameter in patients with intracranial mass, to correlate these changes with optic nerve diameter variations, and to evaluate the impact of hydrocephalus on these alterations. MATERIAL AND METHOD: This study was conducted with patients who presented to our clinic with complaints of intracranial mass, were decided for surgery, and underwent surgical procedures. FINDINGS: The optic nerve and optic nerve sheath diameter measurement values were different preoperatively and postoperatively, with a significant decrease in the optic nerve sheath diameter in all groups in postoperative measurements, while the optic nerve diameter significantly increased. CONCLUSIONS: Although there was no significant difference between the effects of hydrocephalus and intracranial mass-related increase in intracranial pressure on the optic nerve and optic nerve sheath, it was observed that hydrocephalus increased intracranial pressure when considering the Evans ratio. It has been determined that as ventricular dilatation increases, so does intracranial pressure, which leads to an increase in the diameter of the optic nerve sheath, resulting in papilledema and thinning of the optic nerve. These findings indicate the importance of early cerebrospinal fluid diversion and monitoring optic nerve sheath diameter in the management.


Assuntos
Hidrocefalia , Nervo Óptico , Humanos , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/patologia , Hidrocefalia/cirurgia , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Pressão Intracraniana/fisiologia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Papiledema/etiologia , Adulto Jovem , Hipertensão Intracraniana/diagnóstico por imagem , Hipertensão Intracraniana/complicações , Adolescente
10.
Acta Neurochir (Wien) ; 166(1): 240, 2024 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-38814348

RESUMO

BACKGROUND: Intracranial pressure (ICP) monitoring plays a key role in patients with traumatic brain injury (TBI), however, cerebral hypoxia can occur without intracranial hypertension. Aiming to improve neuroprotection in these patients, a possible alternative is the association of Brain Tissue Oxygen Pressure (PbtO2) monitoring, used to detect PbtO2 tension. METHOD: We systematically searched PubMed, Embase and Cochrane Central for RCTs comparing combined PbtO2 + ICP monitoring with ICP monitoring alone in patients with severe or moderate TBI. The outcomes analyzed were mortality at 6 months, favorable outcome (GOS ≥ 4 or GOSE ≥ 5) at 6 months, pulmonary events, cardiovascular events and sepsis rate. RESULTS: We included 4 RCTs in the analysis, totaling 505 patients. Combined PbtO2 + ICP monitoring was used in 241 (47.72%) patients. There was no significant difference between the groups in relation to favorable outcome at 6 months (RR 1.17; 95% CI 0.95-1.43; p = 0.134; I2 = 0%), mortality at 6 months (RR 0.82; 95% CI 0.57-1.18; p = 0.281; I2 = 34%), cardiovascular events (RR 1.75; 95% CI 0.86-3.52; p = 0.120; I2 = 0%) or sepsis (RR 0.75; 95% CI 0.25-2.22; p = 0.604; I2 = 0%). The risk of pulmonary events was significantly higher in the group with combined PbtO2 + ICP monitoring (RR 1.44; 95% CI 1.11-1.87; p = 0.006; I2 = 0%). CONCLUSIONS: Our findings suggest that combined PbtO2 + ICP monitoring does not change outcomes such as mortality, functional recovery, cardiovascular events or sepsis. Furthermore, we found a higher risk of pulmonary events in patients undergoing combined monitoring.


Assuntos
Lesões Encefálicas Traumáticas , Pressão Intracraniana , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Encéfalo/fisiopatologia , Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/terapia , Lesões Encefálicas Traumáticas/fisiopatologia , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/diagnóstico , Pressão Intracraniana/fisiologia , Monitorização Fisiológica/métodos , Monitorização Neurofisiológica/métodos , Oxigênio/análise , Oxigênio/metabolismo
11.
Ann Plast Surg ; 92(6S Suppl 4): S423-S425, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38725113

RESUMO

ABSTRACT: Posterior vault distraction osteogenesis (PVDO) has been shown to resolve acute intracranial hypertension (AIH) while carrying an acceptable perioperative morbidity profile. PVDO has been associated with symptomatic improvement and fewer surgeries in those requiring ventriculoperitoneal shunts. The authors' experience using PVDO as an acute intervention is presented, demonstrating its safety and efficacy for management of AIH. Four cases of children with craniosynostosis that underwent PVDO in the acute setting are outlined. All patients presented with papilledema and symptoms of AIH. One patient with slit ventricle syndrome (SVS) presented with a nonfunctioning shunt following multiple shunt revisions. No intraoperative complications during distractor placement or removal were reported. Distraction protocol for all patients began on postoperative day 1 at 1-2 mm per day, resulting in an average total distraction of 30.25 mm. For the 3 cases with no shunt, the average length of stay was 7 days. As part of the planned treatment course, the patient with SVS required externalization of the shunt during distraction followed by early distractor removal and planned shunt replacement. One case of surgical site infection (in an immunocompromised patient) required premature distractor removal during the consolidation period. Computed tomography (CT) in all patients indicated increased intracranial volume following distraction, and symptomatic improvement was reported. Six-month follow-up showed resolution of papilledema in all patients. The authors' experience using PVDO in the acute setting is reported, alongside a review of current literature, in order to provide supporting evidence for the efficacy of PVDO as a tool for resolving AIH.


Assuntos
Craniossinostoses , Hipertensão Intracraniana , Osteogênese por Distração , Humanos , Osteogênese por Distração/métodos , Hipertensão Intracraniana/cirurgia , Hipertensão Intracraniana/etiologia , Masculino , Feminino , Lactente , Craniossinostoses/cirurgia , Doença Aguda , Pré-Escolar , Tomografia Computadorizada por Raios X
12.
Acta Neurochir (Wien) ; 166(1): 236, 2024 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-38805061

RESUMO

BACKGROUND: Pineal region lesions in children are heterogenous pathologies often symptomatic due to occlusive hydrocephalus and thus elevated intracranial pressure (ICP). MRI-derived parameters to assess hydrocephalus are the optic nerve sheath diameter (ONSD) as a surrogate for ICP and the frontal occipital horn ratio (FOHR), representing ventricle volume. As elevated ICP may not always be associated with clinical signs, the adjunct of ONSD could help decision making in patients undergoing treatment. The goal of this study is to assess the available magnetic resonance imaging (MRI) of patients with pineal region lesions undergoing surgical treatment with respect to pre- and postoperative ONSD and FOHR as an indicator for hydrocephalus. METHODS: Retrospective data analysis was performed in all patients operated for pineal region lesions at a tertiary care center between 2010 and 2023. Only patients with pre- and postoperative MRI were selected for inclusion. Clinical data and ONSD at multiple time points, as well as FOHR were analyzed. Imaging parameter changes were correlated with clinical signs of hydrocephalus before and after surgical treatment. RESULTS: Thirty-three patients with forty operative cases met the inclusion criteria. Age at diagnosis was 10.9 ± 4.6 years (1-17 years). Hydrocephalus was seen in 80% of operative cases preoperatively (n = 32/40). Presence of hydrocephalus was associated with significantly elevated preoperative ONSD (p = 0.006). There was a significant decrease in ONSD immediately (p < 0.001) and at 3 months (p < 0.001) postoperatively. FOHR showed a slightly less pronounced decrease (immediately p = 0.006, 3 months p = 0.003). In patients without hydrocephalus, no significant changes in ONSD were observed (p = 0.369). In 6/6 patients with clinical hydrocephalus treatment failure, ONSD increased, but in 3/6 ONSD was the only discernible MRI change with unchanged FOHR. CONCLUSIONS: ONSD measurements may have utility in evaluating intracranial hypertension due to hydrocephalus in patients with pineal region tumors. ONSD changes appear to have value in assessing hydrocephalus treatment failure.


Assuntos
Hidrocefalia , Imageamento por Ressonância Magnética , Nervo Óptico , Humanos , Hidrocefalia/cirurgia , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Criança , Masculino , Adolescente , Feminino , Estudos Retrospectivos , Pré-Escolar , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/patologia , Nervo Óptico/cirurgia , Lactente , Imageamento por Ressonância Magnética/métodos , Glândula Pineal/cirurgia , Glândula Pineal/diagnóstico por imagem , Glândula Pineal/patologia , Resultado do Tratamento , Falha de Tratamento , Neoplasias Encefálicas/cirurgia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Hipertensão Intracraniana/cirurgia , Hipertensão Intracraniana/diagnóstico por imagem , Hipertensão Intracraniana/etiologia , Pinealoma/cirurgia , Pinealoma/complicações , Pinealoma/diagnóstico por imagem
13.
Nan Fang Yi Ke Da Xue Xue Bao ; 44(4): 660-665, 2024 Apr 20.
Artigo em Chinês | MEDLINE | ID: mdl-38708498

RESUMO

OBJECTIVE: To investigate the effects of different ventilation strategies on intraocular pressure (IOP) and intracranial pressure in patients undergoing spinal surgery in the prone position under general anesthesia. METHODS: Seventy-two patients undergoing prone spinal surgery under general anesthesia between November, 2022 and June, 2023 were equally randomized into two groups to receive routine ventilation (with Vt of 8mL/kg, Fr of 12-15/min, and etCO2 maintained at 35-40 mmHg) or small tidal volume hyperventilation (Vt of 6 mL/kg, Fr of18-20/min, and etCO2 maintained at 30-35 mmHg) during the surgery. IOP of both eyes (measured with a handheld tonometer), optic nerve sheath diameter (ONSD; measured at 3 mm behind the eyeball with bedside real-time ultrasound), circulatory and respiratory parameters of the patients were recorded before anesthesia (T0), immediately after anesthesia induction (T1), immediately after prone positioning (T2), at 2 h during operation (T3), immediately after supine positioning after surgery (T4) and 30 min after the operation (T5). RESULTS: Compared with those at T1, IOP and ONSD in both groups increased significantly at T3 and T4(P < 0.05). IOP was significantly lower in hyperventilation group than in routine ventilation group at T3 and T4(P < 0.05), and ONSD was significantly lower in hyperventilation group at T4(P < 0.05). IOP was positively correlated with the length of operative time (r=0.779, P < 0.001) and inversely with intraoperative etCO2 at T3(r=-0.248, P < 0.001) and T4(r=-0.251, P < 0.001).ONSD was correlated only with operation time (r=0.561, P < 0.05) and not with IOP (r=0.178, P>0.05 at T3; r=0.165, P>0.05 at T4). CONCLUSION: Small tidal volume hyperventilation can relieve the increase of IOP and ONSD during prone spinal surgery under general anesthesia.


Assuntos
Anestesia Geral , Hiperventilação , Pressão Intraocular , Volume de Ventilação Pulmonar , Humanos , Decúbito Ventral , Pressão Intraocular/fisiologia , Anestesia Geral/métodos , Pressão Intracraniana , Coluna Vertebral/cirurgia , Feminino , Masculino , Respiração Artificial/métodos , Hipertensão Intracraniana/cirurgia , Hipertensão Intracraniana/etiologia
14.
Neurosurg Clin N Am ; 35(3): 287-291, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38782521

RESUMO

Idiopathic intracranial hypertension is defined by headaches and a decline in visual acuity due to increased intracranial pressure. Treatment options historically included weight loss, acetazolamide, and/or cerebrospinal fluid diversion surgery. Recent understanding of the contributions of dural venous sinus hypertension and stenosis has led to venous sinus stenting as a treatment option.


Assuntos
Pseudotumor Cerebral , Humanos , Acetazolamida/uso terapêutico , Cavidades Cranianas/cirurgia , Hipertensão Intracraniana/terapia , Pseudotumor Cerebral/cirurgia , Pseudotumor Cerebral/terapia , Stents
15.
Acta Neurochir (Wien) ; 166(1): 234, 2024 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-38805034

RESUMO

PURPOSE: Progressive cerebral edema with refractory intracranial hypertension (ICP) requiring decompressive hemicraniectomy (DHC) is a severe manifestation of early brain injury (EBI) after aneurysmal subarachnoid hemorrhage (aSAH). The purpose of the study was to investigate whether a more pronounced cerebrospinal fluid (CSF) drainage has an influence on cerebral perfusion pressure (CPP) and the extent of EBI after aSAH. METHODS: Patients with aSAH and indication for ICP-monitoring admitted to our center between 2012 and 2020 were retrospectively included. EBI was categorized based on intracranial blood burden, persistent loss of consciousness, and SEBES (Subarachnoid Hemorrhage Early Brain Edema Score) score on the third day after ictus. The draining CSF and vital signs such as ICP and CPP were documented daily. RESULTS: 90 out of 324 eligible aSAH patients (28%) were included. The mean age was 54.2 ± 11.9 years. DHC was performed in 24% (22/90) of patients. Mean CSF drainage within 72 h after ictus was 168.5 ± 78.5 ml. A higher CSF drainage within 72 h after ictus correlated with a less severe EBI and a less frequent need for DHC (r=-0.33, p = 0.001) and with a higher mean CPP on day 3 after ictus (r = 0.2351, p = 0.02). CONCLUSION: A more pronounced CSF drainage in the first 3 days of aSAH was associated with higher CPP and a less severe course of EBI and required less frequently a DHC. These results support the hypothesis that an early and pronounced CSF drainage may facilitate blood clearance and positively influence the course of EBI.


Assuntos
Aneurisma Roto , Drenagem , Hemorragia Subaracnóidea , Humanos , Pessoa de Meia-Idade , Masculino , Hemorragia Subaracnóidea/cirurgia , Hemorragia Subaracnóidea/complicações , Feminino , Drenagem/métodos , Estudos Retrospectivos , Adulto , Aneurisma Roto/cirurgia , Aneurisma Roto/complicações , Idoso , Craniectomia Descompressiva/métodos , Lesões Encefálicas , Edema Encefálico/etiologia , Edema Encefálico/líquido cefalorraquidiano , Edema Encefálico/cirurgia , Líquido Cefalorraquidiano , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/cirurgia , Hipertensão Intracraniana/líquido cefalorraquidiano , Aneurisma Intracraniano/cirurgia , Aneurisma Intracraniano/complicações
16.
Eur J Emerg Med ; 31(4): 287-293, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-38691014

RESUMO

BACKGROUND AND IMPORTANCE: Occurrence of mydriasis during the prehospital management of traumatic brain injury (TBI) may suggest severe intracranial hypertension (ICH) subsequent to brain herniation. The initiation of hyperosmolar therapy to reduce ICH and brain herniation is recommended. Whether mannitol or hypertonic saline solution (HSS) should be preferred is unknown. OBJECTIVES: The objective of this study is to assess whether HSS, compared with mannitol, is associated with improved survival in adult trauma patients with TBI and mydriasis. DESIGN/SETTING AND PARTICIPANTS: A retrospective observational cohort study using the French Traumabase national registry to compare the ICU mortality of patients receiving either HSS or mannitol. Patients aged 16 years or older with moderate to severe TBI who presented with mydriasis during prehospital management were included. OUTCOME MEASURES AND ANALYSIS: We performed propensity score matching on a priori selected variables [i.e. age, sex and initial Coma Glasgow Scale (GCS)] with a ratio of 1 : 3 to ensure comparability between the two groups. The primary outcome was ICU mortality. The secondary outcomes were regression of pupillary abnormality during prehospital management, pulsatility index and diastolic velocity on transcranial Doppler within 24 h after TBI, early ICU mortality (within 48 h), ICU and hospital length of stay. RESULTS: Of 31 579 patients recorded in the registry between 2011 and 2021, 1417 presented with prehospital mydriasis and were included: 1172 (82.7%) received mannitol and 245 (17.3%) received HSS. After propensity score matching, 720 in the mannitol group matched 240 patients in the HSS group. Median age was 41 years [interquartile ranges (IQR) 26-60], 1058 were men (73%) and median GCS was 4 (IQR 3-6). No significant difference was observed in terms of characteristics and prehospital management between the two groups. ICU mortality was lower in the HSS group (45%) than in the mannitol group (54%) after matching [odds ratio (OR) 0.68 (0.5-0.9), P  = 0.014]. No differences were identified between the groups in terms of secondary outcomes. CONCLUSION: In this propensity-matched observational study, the prehospital osmotherapy with HSS in TBI patients with prehospital mydriasis was associated with a lower ICU mortality compared to osmotherapy with mannitol.


Assuntos
Lesões Encefálicas Traumáticas , Serviços Médicos de Emergência , Manitol , Humanos , Manitol/uso terapêutico , Manitol/administração & dosagem , Solução Salina Hipertônica/uso terapêutico , Solução Salina Hipertônica/administração & dosagem , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/terapia , Feminino , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto , Serviços Médicos de Emergência/métodos , França , Escala de Coma de Glasgow , Sistema de Registros , Pontuação de Propensão , Estudos de Coortes , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/tratamento farmacológico , Hipertensão Intracraniana/terapia , Idoso , Diuréticos Osmóticos/uso terapêutico
17.
Artigo em Chinês | MEDLINE | ID: mdl-38563170

RESUMO

Objective:To explore the influencing factors of adult spontaneous meningoencephalocele, which occurs in the lateral recess of sphenoid sinus, in order to improve the level of clinical diagnosis and treatment. Methods:The clinical data of 27 adults with spontaneous meningoencephalocele in lateral recess of sphenoid sinus in Department of the Otorhinolaryngology, the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2022 were retrospectively analyzed. Preoperative sinus CT and MRI were performed to confirm the diagnosis and location of meningoencephalocele. Results:①There were 0 cases of lateral recess of sphenoid sinus type Ⅰ, 8 cases of lateral recess of sphenoid sinus type Ⅱ and 19 cases of lateral recess of sphenoid sinus type Ⅲ. ②Among the 27 adult patients with spontaneous meningoencephalocele, 9 were male and 18 were female, and the onset age was 19-72 years old, with an average age of(50.7±12.4) years old. 18 cases were complicated with cerebrospinal fluid leakage, 11 cases with headache and dizziness, 3 cases with recurrent meningitis(complicated with cerebrospinal fluid leakage), and 2 cases with epilepsy. ③There were 20 patients with intracranial hypertension, 17 patients with body mass index(BMI) ≥25 kg/m², and 8 patients with empty sella. Conclusion:Type Ⅲ of lateral recess of sphenoid sinus is the most common type in adult spontaneous meningoencephalocele, and intracranial hypertension and obesity are the influencing factors of this disease. Puncture, biopsy or operation should not be performed for patients suspected of spontaneous meningoencephalocele, and imaging examination should be performed to identify the source of the tumor.


Assuntos
Hipertensão Intracraniana , Seio Esfenoidal , Adulto , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto Jovem , Idoso , Seio Esfenoidal/patologia , Estudos Retrospectivos , Encefalocele/diagnóstico , Encefalocele/cirurgia , Encefalocele/patologia , Vazamento de Líquido Cefalorraquidiano , Hipertensão Intracraniana/diagnóstico , Hipertensão Intracraniana/patologia , Hipertensão Intracraniana/cirurgia
18.
Childs Nerv Syst ; 40(7): 2125-2134, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38568218

RESUMO

OBJECTIVE: Patients with normocephalic pansynostosis, who have a grossly normal head shape, are often overlooked early in life and present late with elevated intracranial pressure (ICP) requiring timely cranial vault expansion. This study evaluates the long-term clinical outcomes of patients with normocephalic pansynostosis. METHODS: We retrospectively reviewed patients with a clinical and radiographic diagnosis of primary pansynostosis who underwent vault reconstruction between 2000 and 2023. Clinical and treatment course after craniofacial interventions was followed in patients with normocephaly to assess outcomes. RESULTS: Thirty-five patients with primary pansynostosis were identified, of which eight (23.5%) had normocephaly and underwent initial vault expansion at a mean age of 5.0 ± 2.4 years. All eight patients (50.0% male) presented with symptoms of elevated ICP including headaches (50.0%), nausea and vomiting (50.0%), and developmental delay (62.5%) and/or signs of elevated ICP including papilledema (75.0%) and radiologic thumbprinting on head computed tomography scan (87.5%). Three of the four normocephalic patients who had over 7 years of postoperative follow-up developed subjective headaches, vision changes, or learning and behavioral issues in the long-term despite successful vault reconstruction. CONCLUSIONS: Our longitudinal experience with this rare but insidious entity demonstrates the importance of timely intervention and frequent postoperative monitoring, which are critical to limiting long-term neurological sequelae. Multidisciplinary care by craniofacial surgery, neurosurgery, ophthalmology, and neuropsychology with follow-up into adolescence are recommended to assess for possible recurrence of elevated ICP secondary to cranio-cerebral disproportion.


Assuntos
Craniossinostoses , Humanos , Masculino , Feminino , Pré-Escolar , Estudos Retrospectivos , Criança , Craniossinostoses/complicações , Craniossinostoses/cirurgia , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/cirurgia , Hipertensão Intracraniana/complicações , Lactente , Procedimentos de Cirurgia Plástica/métodos , Adolescente
19.
Neurol Clin ; 42(2): 433-471, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575259

RESUMO

Pseudotumor cerebri syndrome is a syndrome of increased cerebrospinal fluid pressure without ventriculomegaly, mass lesion, or meningeal abnormality. It is either primary (idiopathic intracranial hypertension, IIH) or secondary. A secondary cause is unlikely when adhering to the diagnostic criteria. Permanent visual loss occurs if undetected or untreated, and the associated headaches may be debilitating. Fulminant disease may result in blindness despite aggressive treatment. This study addresses the diagnosis and management of IIH including new insights into the pathobiology of IIH, updates in therapeutics and causes of overdiagnosis.


Assuntos
Hipertensão Intracraniana , Papiledema , Pseudotumor Cerebral , Humanos , Pseudotumor Cerebral/diagnóstico , Pseudotumor Cerebral/etiologia , Pseudotumor Cerebral/terapia , Hipertensão Intracraniana/complicações , Cefaleia/diagnóstico , Cefaleia/etiologia , Cefaleia/terapia , Transtornos da Visão/terapia , Síndrome , Papiledema/complicações , Papiledema/diagnóstico
20.
Neurol Clin ; 42(2): 507-520, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575263

RESUMO

Headache affects around half of patients in the acute phase of COVID-19 and generally occurs at the beginning of the symptomatic phase, has an insidious onset, and is bilateral, and of moderate to severe intensity. COVID-19 may also present complications that cause acute and persistent headaches, such as cerebrovascular diseases, rhinosinusitis, meningitis, and intracranial hypertension. In 10% to 20% of patients with COVID-19, headache may persist beyond the acute phase. In general, the headache improves over time. To date, there are no clinical trials that have assessed the treatment of persistent post-COVID-19 headache.


Assuntos
COVID-19 , Hipertensão Intracraniana , Rinossinusite , Humanos , COVID-19/complicações , Cefaleia/etiologia , Hipertensão Intracraniana/complicações
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