1/12. 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) |
2/12. Fatal cerebral air embolism as a complication of transbronchoscopic lung biopsy: a case report.A rare complication of transbronchoscopic lung biopsy, namely a cerebral air embolism, is presented. The course of events following the embolic episode in the form of a fall in blood pressure, bradycardia and convulsions is documented, as is the presence of an air emboli on the CT scan of the brain with subsequent resorption of the emboli on the follow-up scan. The salient features of the case are the rarity of the complication and the excellent temporal depiction of imaging findings on CT scan demonstrated as resorption of air emboli and subsequent watershed territory infarcts.- - - - - - - - - - ranking = 0.16666666666667keywords = pressure (Clic here for more details about this article) |
3/12. Pulmonary barotrauma-induced cerebral arterial gas embolism with spontaneous recovery: commentary on the rationale for therapeutic compression.Pulmonary barotrauma-induced cerebral arterial gas embolism (CAGE) continues to complicate compressed gas diving activities. Inadequate lung ventilation secondary to inadvertent breath holding or rapid buoyant ascent can quickly generate a critical state of lung over-pressure. Pulmonary over-pressurization may also occur as a consequence of acute and chronic pulmonary pathologies. Resulting barotrauma frequently causes structural failure within the terminal distal airway. Respiratory gases are then free to embolize the systemic circulation via the pulmonary vasculature and the left heart. The brain is a common target organ. Bubbles that enter the cerebral arteries coalesce to form columns of gas as the vascular network narrows. Small amounts of gas frequently pass directly through the cerebral circulation without occlusion. Larger columns of gas occlude regional brain blood flow, either transiently or permanently, producing a stroke-like clinical picture. In cases of spontaneous redistribution, a period of apparent recovery is frequently followed by relapse. The etiology of relapse appears to be multifactoral, and chiefly the consequence of a failure of reperfusion. Prediction of who will relapse is not possible, and any such relapse is of ominous prognostic significance. It is advisable, therefore, that CAGE patients who undergo spontaneous recovery be promptly recompressed while breathing oxygen. Therapeutic compression will serve to antagonize leukocyte-mediated ischemia-reperfusion injury; limit potential re-embolization of brain blood flow, secondary to further leakage from the original pulmonary lesion or recirculation of gas from the initial occlusive event; protect against embolic injury to other organs; aid in the resolution of component cerebral edema; reduce the likelihood of late brain infarction reported in patients who have undergone spontaneous clinical recovery; and prophylax against decompression sickness in high gas loading dives that precede accelerated ascents and omitted stage decompression.- - - - - - - - - - ranking = 0.16666666666667keywords = pressure (Clic here for more details about this article) |
4/12. Successful cardic surgery 24 hours after craniotomy in a patient with infective endocarditis and embolic cerebellar infarction: case report.Follow up management in a patient already treated with decompressive craniotomy for a space-occupying endocarditic stroke is difficult. While immediate valve replacement eliminates the focus and therefore the high risk of re-embolization, a neurosurgical intervention is considered a contraindication to early cardiosurgery. Herein, the first report is presented of a critically ill patient with bacterial endocarditis and a space-occupying cerebellar infarction with imminent herniation, who successfully underwent mitral valve replacement only 24 h after decompressive craniotomy. To prevent rebleeding, maximal hemostasis was ensured during the neurosurgical intervention. For cardiosurgery, the patient was cooled to 21 degrees C, mildly hyperventilated, and maintained at an adequate perfusion pressure during cardiopulmonary bypass. A bioprosthesis was used to reduce the time of anticoagulation. The patient did not develop new infarcts after either intervention, and there was only a very small hemorrhagic transformation without a relevant mass effect. At five months after surgery the patient had minimal neurological abnormalities and was able to conduct his daily life without help.- - - - - - - - - - ranking = 0.16666666666667keywords = pressure (Clic here for more details about this article) |
5/12. Progressive neurological decline after partial spontaneous thrombosis of a Spetzler-Martin Grade 5 arteriovenous malformation in a patient with Leiden factor v mutation: management and outcome.The coexistence of a large intracranial arteriovenous malformation (AVM) and a hypercoagulation disorder is rare. The AVM puts the patient at risk for progressive neurological deficit, seizures, and, most importantly, intracranial hemorrhage The hypercoagulation disorder may result in an increased risk of stroke. The authors describe a 42-year-old man with a Spetzler-Martin Grade 5 AVM who experienced progressive neurological decline. He was subsequently discovered to have partial thrombosis of the AVM, deep cerebral and cortical venous thrombosis, and a hypercoagulation disorder. Hypercoagulation disorders causing neurological deficits are usually treated with anticoagulant medications; however, this approach was not thought to be safe in the presence of a large AVM. Therefore, the AVM nidus was surgically extirpated and a ventriculoperitoneal shunt was placed to treat the increased intracranial pressure caused by the cortical and deep cerebral venous thrombosis. Subsequently, lifelong oral anticoagulation was prescribed. The patient had a progressive neurological recovery and is now living independently at home. The occurrence of partial or complete spontaneous thrombosis of an AVM nidus should raise the possibility of an underlying hypercoagulation disorder.- - - - - - - - - - ranking = 0.16666666666667keywords = pressure (Clic here for more details about this article) |
6/12. Thrombus-in-transit causing paradoxical embolism in cerebral and coronary arterial circulation.We describe the case of an elderly man who was admitted to our hospital with the diagnosis of an acute anterior myocardial infarction, together with an acute bioccipital ischaemic stroke. coronary angiography revealed embolization of the distal left anterior descendens and the first septal branch. The definite diagnosis of paradoxical embolism was made by means of a transoesophageal echocardiography which demonstrated a large snake-like floating thrombus crossing a patent foramen ovale. This diagnosis was also supported by the presence of deep venous thrombosis as a probable origin of the intra-atrial thrombus and the secondary pulmonary embolism which contributed to the elevated right heart pressure.The patient was treated with full-dose heparin and subsequently oral anticoagulation. After discharge, follow-up by transoesophageal echocardiography was organized and once the intracardiac thrombus had disappeared, elective transcatheter closure of the patent foramen ovale was performed.- - - - - - - - - - ranking = 0.16666666666667keywords = pressure (Clic here for more details about this article) |
7/12. Visual field defect after posterior spine fusion.STUDY DESIGN: Case report and literature review. OBJECTIVES: review cases and literature regarding visual loss following posterior spine fusion for scoliosis and emphasize right-to-left atrial shunt as a risk factor for paradoxical embolus resulting in a postoperative visual field defect. SUMMARY OF BACKGROUND DATA: The existing literature discusses various possible etiologies of postoperative visual loss including direct pressure, hypotension, blood loss, and anemia. One study shows higher rates of cerebral microemboli in patients with right-to-left atrial shunts. methods: Chart and literature review. RESULTS: A paradoxical embolus to a branch of the central retinal artery resulted in a unilateral quadrant defect (homonymous quadrantanopsia) in a girl with a previously undiagnosed right-to-left atrial shunt. CONCLUSIONS: Right-to-left atrial shunts may predispose to cerebral emboli during scoliosis surgery. These emboli may be a cause of postoperative visual field defects.- - - - - - - - - - ranking = 0.16666666666667keywords = pressure (Clic here for more details about this article) |
8/12. Hyperbaric treatment of cerebral air embolism in an infant with cyanotic congenital heart disease.PURPOSE: Infants with cyanotic congenital heart disease are at risk for cerebral arterial gas embolism (CAGE) from iv infusion lines. Concern about the hazards and difficulty of caring for such patients inside a hyperbaric chamber may deter referral. We report a complex case in which a small infant was managed successfully using a modified hyperbaric oxygen treatment (HBOT) schedule. CLINICAL FEATURES: A four-month-old 6.19 kg male infant with a recent Glenn shunt for double-outlet right ventricle had a seizure and became unstable immediately after an iv drug infusion. The patient was sedated, intubated and ventilated and dobutamine was commenced. A computerized tomography (CT) scan performed ten hours later demonstrated three intracranial air bubbles. About ten hours later the patient was referred for HBOT which commenced soon afterwards in a multiplace chamber. Since the right-to-left shunt would greatly increase the risk of decompression illness from breathing hyperbaric air HBOT was modified by the use of an abbreviated schedule at reduced pressure. Two 90-min HBOT sessions were administered within 24 hr at 38 feet of sea-water pressure, equivalent to 2.15 atmospheres absolute without any air break. During treatment the infant was ventilated using an Oxford Penlon ventilator. A subsequent CT scan demonstrated the absence of air. After extubation he appeared neurologically intact except for some weakness of the left arm. CONCLUSION: Hyperbaric oxygen may be utilized to treat CAGE in small infants with right-to-left shunt and should be commenced promptly.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
9/12. blood pressure in the artery distal to an intraarterial embolus during thrombolytic therapy for occlusion of a major artery: a predictor of cerebral infarction following good recanalization.OBJECT: The aim in this study was the investigation of back pressure in arteries distal to the occlusion site during intraarterial thrombolysis as well as the usefulness of back pressure measurement in combination with diffusion-weighted (DW) magnetic resonance (MR) imaging to predict the occurrence of ischemic lesions following good recanalization. methods:. Twenty-five consecutive patients with severe hemiparesis caused by embolism of the internal carotid artery (10 patients) and the proximal middle cerebral artery (15 patients) were treated using intraarterial thrombolysis. Systolic back pressure, measured through a microcatheter in the artery just distal to the emboli, ranged from 22 to 78 mm Hg. According to an angiographic inclusion criterion for good recanalization--that is, recanalization of the M2 or more distal arteries at the end of thrombolysis--21 of 25 patients underwent evaluation in this study. In 14 patients volumes of low-density areas on computerized tomography (CT) scans obtained 2 months postthrombolysis were smaller in comparison with volumes of hyperintense areas on DW MR images acquired before treatment, whereas these low-density areas were larger in seven patients. Compared with those on initial DW MR images, the volume of abnormalities on CT scans obtained 2 months posttreatment were significantly reduced in patients with a systolic back pressure greater than 30 mm Hg (16 patients) than in those with a back pressure of 30 mm Hg or less (five patients) (p < 0.05). Systolic back pressures greater than 30 mm Hg were associated with significantly better modified Rankin Scale scores than those 30 mm Hg or less (p < 0.05). CONCLUSIONS: back pressure measurement in combination with DW MR imaging can be used to predict the occurrence of infarction as demonstrated on CT scans following thrombolysis.- - - - - - - - - - ranking = 1.8333333333333keywords = pressure (Clic here for more details about this article) |
10/12. Coronary arterial air embolus occurring during cesarean delivery.We present a case of a severe systemic (paradoxical) air embolism occurring during spinal anesthesia for cesarean delivery in an otherwise healthy 35-year-old parturient. Uncomplicated spinal anesthesia and satisfactory surgical anesthesia were obtained; no sedatives were used and the patient was awake and alert and tolerating the procedure well. Immediately following infant and placental delivery (approximately 25 min after the spinal anesthetic was induced) the patient had acute onset of markedly decreased mental status, profound ventricular ectopy and labile blood pressure. The event lasted for approximately 10 min with spontaneous resolution. Neurologic status returned to normal by the end of the surgery, but electrocardiogram findings in the immediate postoperative period were consistent with myocardial ischemia and serial cardiac troponin levels confirmed myocardial injury. On postoperative day 1, an echocardiogram demonstrated the presence of a patent foramen ovale. The events in this case are likely to be due to paradoxical coronary and cerebral air embolism.- - - - - - - - - - ranking = 0.16666666666667keywords = pressure (Clic here for more details about this article) |
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