1/120. Real-time continuous visual biofeedback in the treatment of speech breathing disorders following childhood traumatic brain injury: report of one case.The efficacy of traditional and physiological biofeedback methods for modifying abnormal speech breathing patterns was investigated in a child with persistent dysarthria following severe traumatic brain injury (TBI). An A-B-A-B single-subject experimental research design was utilized to provide the subject with two exclusive periods of therapy for speech breathing, based on traditional therapy techniques and physiological biofeedback methods, respectively. Traditional therapy techniques included establishing optimal posture for speech breathing, explanation of the movement of the respiratory muscles, and a hierarchy of non-speech and speech tasks focusing on establishing an appropriate level of sub-glottal air pressure, and improving the subject's control of inhalation and exhalation. The biofeedback phase of therapy utilized variable inductance plethysmography (or Respitrace) to provide real-time, continuous visual biofeedback of ribcage circumference during breathing. As in traditional therapy, a hierarchy of non-speech and speech tasks were devised to improve the subject's control of his respiratory pattern. Throughout the project, the subject's respiratory support for speech was assessed both instrumentally and perceptually. Instrumental assessment included kinematic and spirometric measures, and perceptual assessment included the Frenchay dysarthria Assessment, Assessment of Intelligibility of Dysarthric speech, and analysis of a speech sample. The results of the study demonstrated that real-time continuous visual biofeedback techniques for modifying speech breathing patterns were not only effective, but superior to the traditional therapy techniques for modifying abnormal speech breathing patterns in a child with persistent dysarthria following severe TBI. These results show that physiological biofeedback techniques are potentially useful clinical tools for the remediation of speech breathing impairment in the paediatric dysarthric population.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/120. rupture of several parasagittal bridging veins without subdural bleeding.This case reports on a fatal craniocerebral trauma involving numerous ruptured cerebral bridging veins that did not bleed subdurally, despite approximately 15 hours of survival. A 15-year-old girl was severely injured as the passenger of a car that crashed sideways into a tree. She-suffered a cerebral trauma of the "diffuse injury" type and was unconscious after the accident. Her computed tomographic scan at admission showed massive brain edema, axial herniation, and marked hypodensity of the bilateral carotid flow area. Despite intensive care measures, the clinical course was characterized by central decompensation with therapy-resistant cardiocirculatory insufficiency. The autopsy revealed ruptures of numerous parasagittal bridging veins. The injured vessels were not thrombosed, and yet there was absolutely no subdural bleeding. This unusual combination of findings is assumed to be caused by an isolated collapse of cerebral circulation occurring shortly after the accident and primarily attributed to a rapid increase of intracranial pressure.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/120. Carotid artery-sygmoid sinus fistula: a rare complication of gunshot wound on the base of the cranium.Vascular lesions without clinical manifestation may occur in cranial-facial wounds produced by bullets that course the base of the cranium. This work describes a rare kind of vascular complication in cranial-facial gunshot wound. The authors present the case of a patient, the victim of a cranium-maxillary gunshot wound. Carotid angiography revealed a carotid-sygmoid sinus fistula that filled the sygmoid and transverse sinuses, concomitant to the arterial angiographic phase. A direct communication between the external carotid artery and the sygmoid sinus was disclosed. We are not aware of any other description of this vascular complication in cranial gunshot wound. It is important to recognize this kind of complication in cases of cranial-facial gunshot wound, because new factors harmful to the brain perfusion systems are introduced, in addition to the alterations to venous return and intracranial pressure, caused by the primary trauma. The new non-invasive vascular diagnostic methods are proving useful in filling the gap left by arteriography, which is no longer used in these cases.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/120. Continuous monitoring of cerebrospinal fluid acid-base balance and oxygen metabolism in patients with severe head injury: pathophysiology and treatments for cerebral acidosis and ischemia.INTRODUCTION: Continuous monitoring of cerebral acid-base balance and oxygen metabolism has been introduced in neurointensive care settings. The hypothesis of this study utilizing multimodal neuromonitoring modalities is that hyperventilation and hypothermia improve cerebral acidosis through prevention of cerebral ischemia aggravation in patients with severe head injury. patients AND methods: Continuous monitoring of cerebrospinal fluid (CSF) pH, PCO2, HCO3-, base excess (BE), PO2, SO2, temperature, lactate and pyruvate (La and Py) measurements were conducted in 8 patients with severe head injury. temperature-corrected CSF parameters were correlated with those in the jugular blood including oxygen saturation (SjO2), regional oxygen saturation (rSO2), intracranial pressure (ICP) and cerebral perfusion pressure (CPP), jugular blood temperature (Tjb), and endtidal PCO2 (PetCO2). Therapeutic significance of hyperventilation and hypothermia was evaluated. RESULTS: 1) CSF acidosis was observed in all cases (minimum pH 6.59-7.17) due to increased CSF PCO2 and/or decreased CSF HCO3- and tended to associate with abnormal ICP and/or CPP or ischemic episodes indicated by CSF PO2 and SO2, rSO2, and/or SjO2 during monitoring. 2) It was more obvious in CSF than in jugular blood that increased PCO2, La and Py, and/or decreased HCO3- resulted in decreased BE and pH. 3) Decreased CSF PO2 and SO2 only correlated with severe CSF acidosis. 4) hyperventilation: Decreased PetCO2 did not always closely correlate with CSF PCO2 decrease and CSFpH increase. 5) hypothermia: There were negative correlations of Tjb with CSF pH and SO2 in all cases, though correlation coefficients were not always high. CONCLUSIONS: CSF acidosis caused by increased CSF PCO2, La and Py, and/or decreased HCO3- tended to associate with abnormal ICP and CPP, and desaturation indicated by CSF SO2, rSO2, and/or SjO2. hypothermia rather than hyperventilation tends to improve cerebral acidosis and ischemia.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
5/120. Central structure preservation of the reversal sign.We report serial changes of central structure preservation of the reversal sign in a case of child abuse. The serial CT images show that the relatively spared attenuation at the basal ganglia, thalami, and posterior fossa develops before the occurrence of transtentorial herniation. This finding makes the theory that central preservation of the reversal sign is due to pressure relief after transtentorial herniation less convincible.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/120. The effect of hyperbaric oxygen treatment on postural stability and gait of a brain injured patient: single case study.Hyperbaric oxygen (HBO) therapy has been found to reduce intracranial and cerebrospinal fluid pressures, and increase grey matter metabolic activity in patients with brain injuries. To date, few studies have quantitatively assessed the changes in the patient's functional outcomes following this expensive therapeutic intervention. The purpose of this case study was to examine the immediate and longer term changes in postural stability and gait in a 17 year old patient who sustained a traumatic brain injury, following administration of hyperbaric oxygen (HBO) therapy combined with physical and occupational therapy. The patient underwent assessments of postural stability and gait 1 week prior to HBO therapy, immediately following, and 6 weeks after completion of HBO therapy. Some improvements in postural stability were observed immediately following HBO, although these improvements were not evident 6 weeks later. Only slight improvements were noted in his walking abilities immediately following the intervention, with essentially little change evident 6 weeks later. The results of this do not support anecdotal evidence that there were substantial improvements in the subject's postural stability and gait following HBO therapy.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/120. flushing in relation to a possible rise in intracranial pressure: documentation of an unusual clinical sign. Report of five cases.This report documents clinical features in five children who developed transient reddening of the skin (epidermal flushing) in association with acute elevations in intracranial pressure (ICP). Four boys and one girl (ages 9-15 years) deteriorated acutely secondary to intracranial hypertension ranging from 30 to 80 mm Hg in the four documented cases. Two patients suffered from ventriculoperitoneal shunt malfunctions, one had diffuse cerebral edema secondary to traumatic brain injury, one was found to have pneumococcal meningitis and hydrocephalus, and one suffered an intraventricular hemorrhage and hydrocephalus intraoperatively. All patients were noted to have developed epidermal flushing involving either the upper chest, face, or arms during their period of neurological deterioration. The response was transient, typically lasting 5 to 15 minutes, and dissipated quickly. The flushing reaction is postulated to be a centrally mediated response to sudden elevations in ICP. Several potential mechanisms are discussed. flushing has clinical importance because it may indicate significant elevations in ICP when it is associated with neurological deterioration. Because of its transient nature, the importance of epidermal flushing is often unrecognized; its presence confirms the need for urgent treatment.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
8/120. Brain tissue pO2 related to SjvO2, ICP, and CPP in severe brain injury.The aim of this report is to present first experience in comparing the course of brain tissue oxygen pressure values (PtiO2) to changes in jugular vein oxygen saturation (SjvO2), intracranial pressure (ICP), and cerebral perfusion pressure (CPP) after severe brain injury. PtiO2 monitoring was done using a polarographic Clark type microcatheter (LICOX pO2 probe) (GMS, Kiel, germany) with a diameter of 0.5 mm and a sensitive area 7.9 mm long inserted in a right frontal position. The microcatheter was connected to a LICOX pO2 device. A fiber-optic catheter was used to measure SjvO2 and placed into the right internal jugular vein. The ICP monitoring was performed with a fiber-optic intraparenchymal device (Camino laboratories, San Diego, Calif.) inserted in a left frontal position. Consistent correlations could be noticed between reduced PtiO2 and higher ICP and lower CPP levels. However, the absolute value of a single SjvO2 data point seemed to be less relevant diagnostically than its trend over a period of time. Owing to their experience, the authors suppose that PtiO2 monitoring will be a very important and reliable tool in the treatment of brain injury in the future, especially in its correlation to ICP and CPP.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
9/120. Isolated medulla oblongata function after severe traumatic brain injury.The objective was to report the first pathologically confirmed case of partly functionally preserved medulla oblongata in a patient with catastrophic traumatic brain injury.A patient is described with epidural haematoma with normal breathing and blood pressure and a retained coughing reflex brought on only by catheter suctioning of the carina. Multiple contusions in the thalami and pons were found but the medulla oblongata was spared at necropsy. In conclusion, medulla oblongata function may persist despite rostrocaudal deterioration. This comatose state ("medulla man") closely mimics brain death.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/120. Penetrating transorbital foreign body with ocular preservation.Large penetrating transorbital foreign bodies may initially appear to be of a devastating character to the ocular tissues. However, several reports of such large foreign bodies have proved to spare the eye. A case report of a large wooden foreign body with transorbital penetration into the right frontal lobe is reported. The globe remained intact and was only displaced, with a final visual acuity of 20/40. However, complete ophthalmoplegia and ptosis persisted. A low pressure hydrocephalus ensued following intracranial debridement.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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