The role of computerized rheoencephalography in the assessment of normal pressure hydrocephalus.

The aim of this study was to determine the relationship between arterial compliance derived from rheoencephalography (REG), and the slope of the regression line between pulse amplitude and mean ICP (AMP/P) recorded during a lumbar infusion study. A hypothetical link between these two variables has been suggested in the past. Resistance to the outflow of cerebrospinal fluid (R(out)) and the slope of the amplitude pressure regression line (AMP/P) were calculated in 62 patients diagnosed with posttraumatic normal pressure hydrocephalus (NPH). In all patients, the changes in cerebral electrical impedance related to the pulsatile component of blood flow were studied noninvasively using computerized rheoencephalography. We classified the REG pulse-related waveform (REGpw) according to the number of the inflection points in the ascending branch, which are a manifestation of the elastic properties of the small arteries. In normal subjects, REGpw corresponded with only one inflection point in the ascending branch (category I). For the purpose of this study, we assumed that the presence of three or greater number of inflection points was characteristic of the regressive changes of the arterial wall (category II). The slope of the AMP/P in patients with the category I REGpw was significantly lower than that in patients with category II (p < 0.05). The association between REGpw category II and the increased slope of the aAMP/P regression line may be related to the transmission of the pulse pressure waveform arterial wall to the CSF compartment, which in turn depends on the elastic properties of the cerebral arteries. The outcome of shunting in patients with REGpw category I was significantly better than that in patients with category II, suggesting that small artery disease may be linked to worse clinical outcomes. Our study indicates that REG examination has potential clinical value in diagnosis and prognosis of NPH.

[Diagnostic problems in epidural hematoma of the posterior cranial fossa]. / Trudnosci diagnostyczne w krwiaku nadtwardówkowym tylnej jamy czaski.

Posttraumatic posterior cranial fossa haematoma is a rare occurrence. In our material it accounted for 1.5% of all intracranial haematomas. Due to its infrequency and diagnostic difficulties these patients are referred with delay to neurosurgeons and often die with signs of brain stem lesion. The reported case was a 25-year-old man with this haematoma and considerable diagnostic difficulties were encountered despite the application of modern imaging techniques. These difficulties hamper the qualification of the patient for operation which is the method of choice in these cases.

[The sinusoidal infusion test--an additional filling test for evaluating the mechanisms of the volume-pressure compensation in the intracranial cerebrospinal fluid space]. / Sinusoidalny test infuzyjny--test dopelnieniowy dla oceny mechanizmów kompensacji objetosciowo-cisnieniowej wewnatrzczaszkowych przestrzeni plynowych.

A diagnostic additional filling test is described which is used for the assessment of the mechanisms of volume-pressure compensation. In the test infusion is used of "physiological" sinusoidal relationship between the infused volume and time. The duration of the test is 10 minutes and it does not require pressure stabilization. On the basis of 23 clinical tests the values were determined of four indices of method "invasiveness" which were compared with analogous indices obtained in the group of tests with stable infusion rate. The obtained results indicate that the sinusoidal test is less invasive and is better tolerated by the patients.

[Meningiomas of the posterior cranial fossa]. / Oponiaki tylnej jamy czaszki

In a period of 3 years 12 patients with meningiomas of the posterior cranial fossa were treated surgically. The group included 2 cases of meningioma situated on the cerebellar convexity, 5 on the tentorium, 2 on the posterior aspect of the pyramid bone, 1 of Blumenbach clivus, 2 of foramen magnum. The neurological findings and pneumoencephylographic changes in cases of meningiomas of cerebellar convexity, tentorium and posterior aspect of the pyramid bone made possible the diagnosis of posterior fossa tumour and the diagnosis of meningioma was made possible by carotid and vertebral angiography. In the case of Blumenbach clivus meningioma and in foramen magnum meningiomas the neurological changes were characteristic of tumours at the craniovertebral junction. One meningioma growing through the tentorium was approached from the middle cranial fossa, the remaining ones from the posterior cranial fossa. The tumour could have been removed radically in 7 cases. In 5 cases only partial removal was possible. Three patients died, two after operations for tentorial meningioma and one after operation for Blumenbach clivus tumour. The results in the remaining cases were good.

[Effect of general anesthesia induction on cerebral circulation in subacute and chronic subdural hematoma assesssed by computerized rheo-encephalography]. / Wplyw indukcji znieczulenia ogólnego na krazenie mózgowe w podostrym i przewleklym krwiaku podtwardówkowym na podstawie skomputeryzowanej reoencefalografii.

Cerebral circulation in 21 patients with subacute (SSH) and chronic subdural hematoma (CSH) were studied by computerized rheoencephalography before and after induction of general anesthesia. ECG and REG courses were sampled with a frequency of 62.5 Hz during a period of 15 minutes, and both sets of data points were fitted by an cubic polynomials. We introduced the classification of the REG pulse related waveform (PRW) according to the number of the inflection points in the anacrotic branch. The cases of normal pulse form, with almost vertical systolic upstroke corresponded with only one inflection point in the ascending branch (grade I). We assumed that the presence of three or greater number of inflection points reflected more gradual systolic rise, is characteristic for regressive changes of the arterial wall (grade II). The relative duration of the anacrotic branch was calculated. The first obtained result was the significant correlation between REG and clinical status. The unfavorable effect of induction on cerebral circulation corresponded with less favorable results of treatment. Our preliminary results indicate the clinical value of REG examination in the preoperative evaluation of the cerebral circulation.

[Neurotrauma in treatment of nervous system injuries--principles in cooperating with anesthesiologists]. / Neurotraumatolog w leczeniu obrazen osrodkowego ukladu nerwowego--zasady wspólpracy z anestezjologiem.

After brain trauma neuronal degeneration results due to the combination of primary mechanical disruption of CNS parenchyma and the secondary pathophysiological events. The fact that the treatment can modified the clinical course and the final outcome, implies that is indeed a modifiable secondary neurodegenerative process which is caused by the mechanical injury. Contemporary in patients with craniocerebral trauma and with polytrauma our management is focused on prevention of secondary brain injury. On the accident scene that is crucial to appropriate ventilate the patient, stabilize blood pressure and prevent shock. The diagnostic tool of choice is CT, but made in the very early stage could revealed false negative scan. That could be the cause of missed beginning of intracranial pressure increase in artificially ventilated patients. Multimodality monitoring in highly specialized centers could enable early detection of such increase (ICP) and help in estimation of indication for surgical treatment. The mechanism, direct sequelae of head trauma and neurological symptoms dynamics are also important.

[Experiments in evaluation of brain oxygenation and metabolism based on continuous bilateral SjO2 monitoring and metabolic glucose transformations in patients after severe cranio-cerebral injuries]. / Wlasne doswiadczenia w ocenie oksygenacji i metabolizmu mózgu na podstawie ciaglego obustronnego monitorowania SJO2 oraz przemiany metabolicznej glukozy u chorych po ciezkich urazach czaszkowo-mózgowych.

The study group consisted of 17 patients after severe cranio-cerebral injuries-in GCS below 8. Saturation in both jugular bulbs was measured by using fiberoptic catheters, the concentration of lactate taken from jugular bulbs was measured too. These values were compared to concentration in peripheral arteries. All measurements were started within the first 24 h after trauma and lasted 5 days. Diagnosis of intracranial pathology was established by using CT, which was done directly after admission to the hospital. Interdependence between the state of patient in GOS and variability saturation and concentration of lactate was showed. Desaturation occurred before the neurological sings of intracranial hypertension what had influence on way of treatment and diagnostics. Bilateral measurement of the saturation is more useful to make diagnostic unilateral measurement.

The role of cerebrospinal compensatory parameters in the estimation of functioning of implanted shunt system in patients with communicating hydrocephalus (preliminary report).

Twelve patients presenting with communicating hydrocephalus were studied. In 9 cases where the mean ICP level remained below 10 mmHg the symptoms of normal pressure hydrocephalus were observed. All of the patients were treated by shunt system implantation. The clinical and psychological state, cranial computerized tomography and parameters of the cerebrospinal compensatory mechanisms, evaluated using the constant rate infusion test were compared before and after treatment. In most of the patients (11) the pathologically enlarged ventricles persisted. Only in three cases no clinical improvement was noticed. In this group the resistance to the cerebrospinal fluid absorption and the fluid formation rate were estimated as normal. In the group with improvement the normalization of the resistance (4), decrease in the cerebrospinal fluid formation rate (4) and decrease in the cerebrospinal system elasticity (1) can be pointed out as factors responsible for improvement manifested after shunting. Therefore the resorption resistance and the formation of cerebrospinal fluid should be considered as predictive factors in the shunt implantation in hydrocephalic patients, and play an important role in the diagnosis of this entity.