1/5. intracranial pressure within a developing intracerebral haemorrhage.We report the time course of intracranial pressure within a developing intracerebral haemorrhage. Simultaneous readings of intracranial pressure were obtained from a contralateral parenchymal monitor and ventricular fluid pressure monitor. This recording demonstrates the existence of large pressure gradients in patients with expanding mass lesions.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/5. Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury.OBJECT: Progressive intracranial hemorrhage after head injury is often observed on serial computerized tomography (CT) scans but its significance is uncertain. In this study, patients in whom two CT scans were obtained within 24 hours of injury were analyzed to determine the incidence, risk factors, and clinical significance of progressive hemorrhagic injury (PHI). methods: The diagnosis of PHI was determined by comparing the first and second CT scans and was categorized as epidural hematoma (EDH), subdural hematoma (SDH), intraparenchymal contusion or hematoma (IPCH), or subarachnoid hemorrhage (SAH). Potential risk factors, the daily mean intracranial pressure (ICP), and cerebral perfusion pressure were analyzed. In a cohort of 142 patients (mean age 34 /- 14 years; median glasgow coma scale score of 8, range 3-15; male/female ratio 4.3: 1), the mean time from injury to first CT scan was 2 /- 1.6 hours and between first and second CT scans was 6.9 /- 3.6 hours. A PHI was found in 42.3% of patients overall and in 48.6% of patients who underwent scanning within 2 hours of injury. Of the 60 patients with PHI, 87% underwent their first CT scan within 2 hours of injury and in only one with PHI was the first CT scan obtained more than 6 hours postinjury. The likelihood of PHI for a given lesion was 51% for IPCH, 22% for EDH, 17% for SAH, and 11% for SDH. Of the 46 patients who underwent craniotomy for hematoma evacuation, 24% did so after the second CT scan because of findings of PHI. Logistic regression was used to identify male sex (p = 0.01), older age (p = 0.01), time from injury to first CT scan (p = 0.02), and initial partial thromboplastin time (PTT) (p = 0.02) as the best predictors of PHI. The percentage of patients with mean daily ICP greater than 20 mm Hg was higher in those with PHI compared with those without PHI. The 6-month postinjury outcome was similar in the two patient groups. CONCLUSIONS: Early progressive hemorrhage occurs in almost 50% of head-injured patients who undergo CT scanning within 2 hours of injury, it occurs most frequently in cerebral contusions, and it is associated with ICP elevations. Male sex, older age, time from injury to first CT scan, and PTT appear to be key determinants of PHI. Early repeated CT scanning is indicated in patients with nonsurgically treated hemorrhage revealed on the first CT scan.- - - - - - - - - - ranking = 0.25keywords = pressure (Clic here for more details about this article) |
3/5. Sinking skin flap syndrome: a case of improved cerebral blood flow after cranioplasty.Sinking skin flap syndrome is defined as a series of neurologic symptoms with the skin depression at the site of cranial defect, which develop several weeks to months after large external cerebral decompression.The case of a 28-year-old female with the sinking skin flap syndrome is reported together with the evaluation of cerebral blood flow using xenon computed tomography (CT). Although her general condition stabilized within 7 months after the injury, the skin of the bilateral temporal regions was markedly depressed due to large bone defects. She was confined to bed and showed reduced levels of consciousness. We decided to treat this case by performing cranioplasty with a hydroxyapatite ceramic implant. Not only were good cranial contour reconstructed after cranioplasty, but neurologic conditions were also improved after cranioplasty.Regarding the change in cerebral blood flow in the present case, as measured with xenon CT, the cerebral blood flow 3 days after the injury was 18.7 /- 12.3 mL/100 mL/min and 26.5 /- 11.6 mL/100 mL/min in the left and right hemispheres, respectively. After the bilateral cranioplasty, it had increased by approximately 2-fold to 36.4 /- 23.2 mL/100 mL/min in the left hemisphere and approximately 1.5-fold to 43.8 /- 23.3 mL/100 mL/min in the right hemisphere as compared with the levels obtained 3 days after the injury.Therefore, xenon CT appears to be useful in the monitoring of regional cerebral blood flow in patients with cranial bone defects that are directly affected by atmospheric pressure and in predicting functional prognosis. For the sinking skin flap syndrome cases, cranioplasty is not only useful for cerebral protection and improvement of appearance, but cranioplasty is also useful for improving neurologic symptoms.- - - - - - - - - - ranking = 0.125keywords = pressure (Clic here for more details about this article) |
4/5. Intracerebral haematoma masquerading as ventricular standstill.An 82 year old man was referred to the emergency room by his general practitioner for a right frontoparietal headache. The preceding day he had tripped and fallen, hitting the back of his head on the floor. Computed tomography showed a cortical contre coup haematoma. In view of ventricular standstill noted on ECG, a temporary pacing wire was inserted and a dual chamber permanent pacemaker was subsequently implanted. Intracerebral bleeding was treated conservatively and the patient made a good recovery. All patients admitted with head injury and sinus bradycardia or sinus arrest should be nursed at 15 degrees to 30 degrees with instructions to avoid the head up and supine positions. Furthermore, brain CT should be promptly recorded to assess for intracerebral haematoma and raised intracranial pressure and, if they are confirmed, these patients with cardiovascular compromise should benefit from close collaboration between neurosurgeon and cardiologist. Urgent pacing should be considered for all patients with head injury who experience symptomatic bradycardia or ventricular standstill.- - - - - - - - - - ranking = 0.125keywords = pressure (Clic here for more details about this article) |
5/5. Two cases of hyperkalemia after administration of hypertonic mannitol during craniotomy.mannitol is used commonly as an osmotic diuretic to reduce intracranial pressure during the perioperative period of craniotomy. The rapid administration of mannitol solution can cause an imbalance of electrolytes such as sodium and potassium. Here, we report two cases of mannitol-induced hyperkalemia. We demonstrate that administration of mannitol during craniotomy increases potassium iron concentration, and in some cases it may cause disturbance of cardiac function.- - - - - - - - - - ranking = 0.125keywords = pressure (Clic here for more details about this article) |