1/18. propofol for sedation and control of intracranial pressure in children.Following central nervous system insults, control of intracranial pressure may lessen the incidence of morbidity and mortality. Therapies to control intracranial pressure include osmolar agents, prevention of and control of seizures, drainage of cerebrospinal fluid, hypothermia, and barbiturates. Control of agitation and excessive patient movement are additional components in the management of ICP. Although opioids and benzodiazepines are generally effective, in a small subset of patients, alternative agents may be necessary. The authors present 2 children with increased ICP in whom propofol was used to provide sedation and control ICP. The use of propofol in this setting and its possible applications in the children with increased ICP are discussed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/18. Metabolic acidosis, rhabdomyolysis, and cardiovascular collapse after prolonged propofol infusion.The authors present the hospital course of a 13-year-old girl with a closed head injury who received a prolonged infusion of propofol for sedation and, subsequently, died as a result of severe metabolic acidosis, rhabdomyolysis, and cardiovascular collapse. The patient had been treated for 4 days at a referring hospital for a severe closed head injury sustained in a fall from a bicycle. During treatment for elevations of intracranial pressure, she received a continuous propofol infusion (100 microg/kg/min). The patient began to exhibit severe high anion gap/low lactate metabolic acidosis, and was transferred to the pediatric intensive care unit at the authors' institution. On arrival there, the patient's glasgow coma scale score was 3 and this remained unchanged during her brief stay. The severe metabolic acidosis was unresponsive to maximum therapy. Acute renal failure ensued as a result of rhabdomyolysis, and myocardial dysfunction with bizarre, wide QRS complexes developed without hyperkalemia. The patient died of myocardial collapse with severe metabolic acidosis and multisystem organ failure (involving renal, hepatic, and cardiac systems) approximately 15 hours after admission to the authors' institution. This patient represents another case of severe metabolic acidosis, rhabdomyolysis, and cardiovascular collapse observed after a prolonged propofol infusion in a pediatric patient. The authors suggest selection of other pharmacological agents for long-term sedation in pediatric patients.- - - - - - - - - - ranking = 0.16666666666667keywords = pressure (Clic here for more details about this article) |
3/18. Applying circular posterior-hinged craniotomy to malignant cerebral edemas.Malignant brain edemas are often fatal, regardless of whether they are treated conservatively with sedation, blood pressure management, mannitol-therapy, hyperventilation and hypothermia, or non-conservatively with routine trepanation. Unfortunately, temporal trepanation may result in significant brain damage through herniation of the cerebrum at the edges of the trepanation openings. In one case of a 26-year-old male with severe head injury, a circular posterior-hinged craniotomy (CPHC) was performed after an ineffective unitemporal trepanation for evacuation of an acute subdural hematoma. This ultimately successful operation prompted experimental and morphologic investigations on a new surgical procedure for lowering intracranial pressure (ICP). In 12 of 15 human cadavers, an experimentally ICP was lowered by a CPHC with between 9-21 mm of frontal elevation of the calvaria. Using computer simulation, the frontal elevations of the calvaria were "virtually" performed on 3D reconstructions from CT scans of skulls, and the intracranial volume gained was measured with a computer software program. The volume increase of the cranial cavity showed a relatively constant relation to the cranial capacity and was increased by 6.0% ( /-0.4%) or 78 cm(3) with a 10 mm elevation and by 12.4% ( /-0.7%) or 160 cm(3) with a 20 mm elevation. There were no significant differences with skulls of different ages or ethnic origin; however, a significant effect of gender (F = 7.074; P < or = 0.013) on the gained volume in percent of the cranial capacity for the 20 mm elevation was observed. This difference can be explained by the inverse relationship between volume increase and cranial capacity (r = -0.507; P < or = 0.004).- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
4/18. Rapid neurological deterioration associated with minor head trauma in chronic hydrocephalus.CASE REPORT: An 8-year-old developmentally normal boy (status: post third ventriculostomy and resection of posterior fossa low-grade glioma 4 years earlier and with known history of ventriculomegaly/arrested hydrocephalus) presented to the emergency room with vomiting and lethargy after a minor head trauma. Computed tomography scan of the head revealed no acute changes since previous studies. However, the patient's neurological status rapidly declined in the emergency room, where an emergency ventriculostomy demonstrated increased intracranial pressure. The patient's clinical condition improved over 24 h: he underwent placement of a ventriculoperitoneal shunt without complications and was discharged intact. DISCUSSION: The pathogenesis of rapid neurological decline associated with minor head trauma in chronic hydrocephalus is reviewed.- - - - - - - - - - ranking = 0.16666666666667keywords = pressure (Clic here for more details about this article) |
5/18. Uncommon cause of sinus thrombosis following closed mild head injury in a child.OBJECT: Sinus thrombosis following a closed mild head injury is rare. A case of dural sinus thrombosis following a mild closed head injury due to an uncommon cause is reported. methods: A 7-year-old child presented with GCS 15 after a road traffic accident. CT revealed an occipital fracture. Ten days later the child developed signs of increased intracranial pressure. An MR venogram at this time revealed thrombosis of the transverse sinus with hypoplasia of the contralateral transverse and sigmoid sinuses. The patient's anitiphospholipid antibody titres were elevated. The patient was treated with anticoagulants and improved. CONCLUSIONS: The role of inherited and acquired procoagulant factors in the aetiology of sinus thrombosis is increasingly being recognized. When a patient presents with sinus thrombosis after a closed mild head injury, it is necessary to investigate for the presence of risk factors for thrombophilia as it has implications for the long-term management of the patient.- - - - - - - - - - ranking = 0.16666666666667keywords = pressure (Clic here for more details about this article) |
6/18. High-dose dexamethasone therapy in head injury: a patient group that may benefit from therapy.Three patients with head injuries and focal areas of low density on CT who deteriorated progressively with uncontrollable rising intracranial pressure (ICP) are described. High-dose dexamethasone therapy was followed by a substantial decrease in ICP during the following 24 h. Features that the patients had in common are a young age group, an initial GCS of 10 or more and an elevation of ICP 2 days or longer after admission.- - - - - - - - - - ranking = 0.16666666666667keywords = pressure (Clic here for more details about this article) |
7/18. Retinal nerve fiber layer thickness in optic tract syndrome.BACKGROUND: Optic tract syndrome (OTS) is characterized by incongruous homonymous hemianopia and a perpendicular pattern of bilateral optic atrophy due to the optic tract lesion. However, loss of retinal nerve fiber layer thickness (RNFLT) associated with OTS has not been quantitatively assessed. CASE: A 20-year-old woman with blunt head trauma showed normal visual acuity, color vision, ocular motility, and intraocular pressure. Because of a relative afferent pupillary defect in her left eye and left-sided homonymous hemianopia, we suspected right-sided optic tract damage, although magnetic resonance imaging detected no intracranial lesion. OBSERVATIONS: Using optical coherence tomography (OCT), the RNFLT of this case was measured at 31 months after the trauma and compared with age-matched normal controls (n = 41). Nasal, temporal, superior, and inferior quadrant RNFLT was reduced by 22%, 21%, 5%, and 46% in the right eye and 76%, 64%, 25%, and 27% in the left eye, respectively. The reduction was > 3 x the standard deviation of the normal mean values in the nasal and temporal quadrants of the left eye and in the inferior quadrant of the right eye. CONCLUSIONS: OCT can determine the RNFLT reduction corresponding to the characteristic patterns of optic atrophy of OTS.- - - - - - - - - - ranking = 0.16666666666667keywords = pressure (Clic here for more details about this article) |
8/18. Significant lateralisation of supratentorial ICP after blunt head trauma.After blunt head trauma simultaneous left and right hemispheric intracranial pressure (ICP) monitoring revealed a pressure gradient of about 30 mmHg persisting until the 5th day after the accident equilibrating thereafter. ICP was elevated over the radiologically more compressed hemisphere. The supratentorial space seems to allow considerable interhemispheric pressure gradients. As a consequence epidural ICP monitoring should be performed over the hemisphere with signs of greater compression.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
9/18. Superior sagittal sinus thrombosis associated with raised intracranial pressure in closed head injury with depressed skull fracture.A case of delayed signs of intracranial hypertension following closed head injury with a depressed cranial fracture and superior sagittal sinus thrombosis is reported. Conservative treatment of intracranial hypertension, including just repeated lumbar puncture and oral acetazolamide, was performed. Spontaneous recanalization of the superior sagittal sinus was observed. Pathogenesis and different modalities of treatment are discussed.- - - - - - - - - - ranking = 0.66666666666667keywords = pressure (Clic here for more details about this article) |
10/18. Epidural haematoma after evacuation of contralateral subdural haematoma.BACKGROUND: Sequentially evolving intracranial bilateral haematomas, where the second haematoma develops after the surgical removal of the first one is rarely reported. AIM: To report a patient who developed an epidural haematoma after evacuation of a contralateral subdural haematoma. methods: A 49-year-old male was admitted to our department after head injury. A brain computerized tomography (CT) scan revealed an acute subdural haematoma in the right temporal area which was evacuated. During his stay in the intensive care unit, he was submitted to intracranial pressure monitoring, which soon rose. RESULTS: A new CT scan showed an acute epidural haematoma in the contralateral parietal area that was also evacuated. CONCLUSIONS: While rising intracranial pressure after the evacuation of a traumatic haematoma is usually attributed to brain oedema or recurrent haematoma at the craniotomy site, the development of a contralateral epidural haematoma requiring surgical treatment should not be overlooked.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
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