1/159. The possible role of hypoxia in the formation of axonal bulbs.AIMS: To assess the possible role of hypoxia in the formation of axonal bulbs. methods: Study material comprised sections from 28 brains showing evidence of cerebral hypoxia with no history of head injury, four with a history of head trauma but no evidence of hypoxic change, eight with a history of head trauma and hypoxic change, and four from control brains originally described as "diffuse axonal injury." These were subjected to microwave antigen retrieval and immunohistochemistry using monoclonal antibodies to beta amyloid precursor protein (beta APP), glial fibrillary acid protein (GFAP), and CD68-PGM1. RESULTS: Positive staining for beta APP was seen in all four controls, all four cases of head injury only, seven of eight cases of head injury and hypoxic changes, and 12 of 28 cases of hypoxia without history of head injury; 22 of 25 cases who had been ventilated showed positive staining. The majority of cases showed evidence of cerebral swelling. CONCLUSIONS: Axonal bulbs staining positively for beta APP may occur in the presence of hypoxia and in the absence of head injury. The role of hypoxia, raised intracranial pressure, oedema, shift effects, and ventilatory support in the formation of axonal bulbs is discussed. The presence of axonal bulbs cannot necessarily be attributed to shearing forces alone.- - - - - - - - - - ranking = 1keywords = brain, injury, trauma (Clic here for more details about this article) |
2/159. Sudden death and cerebral anoxia in a young woman with congenital ostial stenosis of the left main coronary artery.We report a 36-year-old woman with ventricular fibrillation, subsequent sudden clinical cardiac death, and a prolonged brain anoxia. After a successful resuscitation coronary angiography revealed congenital ostial left main coronary artery (LMCA) stenosis. Surgical anastomosis of the left internal mammary artery (LIMA) to LAD led to a complete recovery. Postoperative electrophysiological examination, mainly programmed ventricular stimulation, failed to excite any rhythm disturbances. Cathet. Cardiovasc. Intervent. 48:67-70, 1999.- - - - - - - - - - ranking = 0.48298611801106keywords = brain (Clic here for more details about this article) |
3/159. Biochemical changes related to hypoxia during cerebral aneurysm surgery: combined microdialysis and tissue oxygen monitoring: case report.OBJECTIVE AND IMPORTANCE: The objective of this study was to monitor brain metabolism on-line during aneurysm surgery, by combining the use of a multiparameter (brain tissue oxygen, brain carbon dioxide, pH, and temperature) sensor with microdialysis (extracellular glucose, lactate, pyruvate, and glutamate). The case illustrates the potential value of these techniques by demonstrating the effects of adverse physiological events on brain metabolism and the ability to assist in both intraoperative and postoperative decision-making. CLINICAL PRESENTATION: A 41-year-old woman presented with a World Federation of Neurological Surgeons Grade I subarachnoid hemorrhage. Angiography revealed a basilar artery aneurysm that was not amenable to coiling, so the aneurysm was clipped. Before the craniotomy was performed, a multiparameter sensor and a microdialysis catheter were inserted to monitor brain metabolism. INTERVENTION: During the operation, the brain oxygen level decreased, in relation to biochemical changes, including the reduction of extracellular glucose and pyruvate and the elevation of lactate and glutamate. These changes were reversible. However, when the craniotomy was closed, a second decrease in brain oxygen occurred in association with brain swelling, which immediately prompted a postoperative computed tomographic scan. The scan demonstrated acute hydrocephalus, requiring external ventricular drainage. The patient made a full recovery. CONCLUSION: The monitoring techniques influenced clinical decision-making in the treatment of this patient. On-line measurement of brain tissue gases and extracellular chemistry has the potential to assist in the perioperative and postoperative management of patients undergoing complex cerebrovascular surgery and to establish the effects of intervention on brain homeostasis.- - - - - - - - - - ranking = 4.8298611801106keywords = brain (Clic here for more details about this article) |
4/159. cardiopulmonary bypass technique for treatment of renal cell carcinoma extending into the vena cava.cardiopulmonary bypass (CPB) is a unique technique used widely for renal cell carcinoma patients showing inferior vena cava invasion. We used a modification of CPB technique for 2 patients. These patients were managed with CPB without cross clamping and so without cold potassium cardioplegia. The primary tumor was a renal cell carcinoma propagating into the inferior vena cava and going into the right atrium as a thrombus in both patients. As a surgical procedure the urology team did nephrectomy and then with our clinical techniques we used CPB to cool the patients to 20 degrees C and decreased the flow to 500 ml/min/m2. The heart went into spontaneous ventricular fibrillation without using cross clamping and cardioplegia. Then we did atrial and inferior vena caval thrombectomy in a bloodless and visible operation field within a safe time interval. The aim of using this technique is to prevent myocardial injury and to protect the brain from hypoxia by using this low flow technique. This method can be used safely for the management of renal cell carcinomas and for some retroperitoneal malignancies associated with vena caval and atrial involvement.- - - - - - - - - - ranking = 0.48865407817339keywords = brain, injury (Clic here for more details about this article) |
5/159. Intraocular contrast enhancement in Adams pattern III hypoxic brain damage: MRI.The MRI findings of a patient with diffuse cortical hypoxic brain damage (Adams pattern III) are presented. Besides intense cortical contrast enhancement, a peculiar leakage of contrast medium at the anterior chambers of the eye was observed. The pathogenetic mechanism of this enhancement is discussed.- - - - - - - - - - ranking = 2.4149305900553keywords = brain (Clic here for more details about this article) |
6/159. The shaking trauma in infants - kinetic chains.The findings in three children who died as a consequence of shaking and those in another child who survived are presented. In the three fatal cases, a combination of anatomical lesions were identified at autopsy which appear to indicate the sites where kinetic energy related to the shaking episodes had been applied thus enabling the sequence of events resulting in the fatal head injury to be elucidated. Such patterns of injuries involved the upper limb, the shoulder, the brachial nerve plexus and the muscles close to the scapula; hemorrhages were present at the insertions of the sternocleidomastoid muscles due to hyperextension trauma (the so-called periosteal sign) and in the transition zone between the cervical and thoracic spine and extradural hematomas. Characteristic lesions due to traction were also found in the legs. All three children with lethal shaking trauma died from a subdural hematoma only a few hours after the event. The surviving child had persistant hypoxic damage of the brain following on massive cerebral edema. All the children showed a discrepancy between the lack of identifiable external lesions and severe internal ones.- - - - - - - - - - ranking = 0.48871408718501keywords = brain, injury, trauma (Clic here for more details about this article) |
7/159. music and the brain: the impact of music on an oboist's fight for recovery.A 20-year-old female, alias Sara, was an aspiring professional oboist who studied music performance at college level. While wading across a river she lost her balance, was swept down river, and suffered profound injuries including severe hypothermia, cardiac arrest, and hypoxic brain injury. While recovering, her family and friends surrounded Sara with music. Her oboe teacher placed Sara's oboe in her hand and played tapes of Sara's past performances. Her mother played recordings of her favourite music in hopes that the music would remind her of her life's passion and, thus, stimulate her mind and soul while she recovered. Two years post-injury, Sara continues to strive to improve her quality of life. In this case study, Sara's musical and medical recovery is detailed using quantitative and qualitative data. This data gathered allows one to provide an analysis of the powerful role of music in Sara's fight to recover.- - - - - - - - - - ranking = 3.0152170834817keywords = brain injury, brain, injury (Clic here for more details about this article) |
8/159. Traumatic asphyxia complicated by unwitnessed cardiac arrest.We report a case of traumatic asphyxia complicated by unwitnessed cardiac arrest in which the patient has made a good, functional recovery. Traumatic asphyxia is an uncommon clinical syndrome usually occurring after chest compression. Associated physical findings include subconjunctival hemorrhage and purple-blue neck and face discoloration. These facial changes can mimic those seen with massive closed head injury; however, cerebral injury after traumatic asphyxia usually occurs due to cerebral hypoxia. When such features are observed, the diagnosis of traumatic asphyxia should be considered. Prompt treatment with attention to the reestablishment of oxygenation and perfusion may result in good outcomes.- - - - - - - - - - ranking = 0.011365924830482keywords = injury, trauma (Clic here for more details about this article) |
9/159. Anaesthetic management of a pregnant patient in a persistent vegetative state.pregnancy in a patient in a persistent vegetative state presents challenging therapeutic questions about the level of supportive management required, the assessment of fetal well-being, the timing and mode of delivery and the anaesthetic management of labour and delivery. We report the case of a 29-yr-old woman who had a favourable fetal outcome despite suffering hypoxic brain damage after a suicide attempt by a drug overdose. She was managed until the onset of labour on an intensive care unit and had a spontaneous vaginal delivery assisted by epidural anaesthesia.- - - - - - - - - - ranking = 0.48298611801106keywords = brain (Clic here for more details about this article) |
10/159. anorexia nervosa remission during an episode of encephalitis.OBJECTIVE: The case described suggests that there may be a neurobiological aspect to the etiology of anorexia nervosa (AN) and that development of new pharmacological treatment strategies aimed at the central nervous system (CNS) may be possible. METHOD: A 25-year-old female with AN lost her anorexic behaviors following an episode of encephalitis with associated hypoxic brain injury. Once the neurological sequelae resolved, the anorexic behaviors returned. RESULTS: During recovery, the patient's weight increased from 37.8 to 51.1 kg and body fat content by skinfold measurement increased from 7.5% to 18.5%. DISCUSSION: If a neurophysiological mechanism underlying AN could be identified, it might be possible to devise new treatment options.- - - - - - - - - - ranking = 1.0776046512751keywords = brain injury, brain, injury (Clic here for more details about this article) |
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