Frontiers of neurology and neuroscience
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Front Neurol Neurosci · Jan 2015
ReviewNon-invasive transcranial brain ablation with high-intensity focused ultrasound.
The idea to ablate brain tissue with high-intensity focused ultrasound (HIFU) in a highly precise and localized manner is relatively old. For HIFU tissue ablation, ultrasound (US) waves are concentrated to a focal point. Due to US absorption, the focal area will be heated and consequently thermally destroyed. ⋯ However, there were serious adverse effects in two cases, where intracranial hemorrhages appeared due to the induction of cavitation. Based on these encouraging clinical results, more extensive clinical studies have been initiated. Transcranial MRgFUS is a fast-growing field of neurological research with high clinical potential.
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Front Neurol Neurosci · Jan 2015
ReviewNew Insights into Blood Pressure Control for Intracerebral Haemorrhage.
Although blood pressure (BP) levels may rise in the weeks preceding intracerebral haemorrhage (ICH), in contrast to findings in the ischaemic stroke population, the initial post-ICH BP is often much higher than the last pre-morbid level. Elevated BP is therefore common in acute ICH, often with markedly elevated levels, and is associated with poor outcomes, though the exact pathophysiological mechanisms remain unclear. The Antihypertensive Treatment of Acute Cerebral Haemorrhage (ATACH) trial and the INTEnsive blood pressure Reduction in Acute Cerebral haemorrhage Trial (INTERACT) demonstrated that early and intensive lowering of elevated BP in the acute ICH period is feasible and safe. ⋯ BP lowering in acute ICH may reduce haematoma growth, particularly when target levels are achieved early and are sustained, though the evidence is partly conflicting. Other aspects of BP may also be important following acute ICH, with maximum systolic BP and systolic BP variability being independent predictors of poor outcomes in a recent study. This chapter gives an overview of the current evidence regarding BP in ICH and covers the following topics: the incidence of elevated BP in acute ICH and the patterns of BP observed before and after the event; the effect of elevated BP on outcomes in ICH and the potential underlying pathophysiological mechanisms; the safety and feasibility of BP lowering; the effects of BP lowering on clinical and radiological outcomes; other important aspects of BP in ICH; and the choice of antihypertensive agent.
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Front Neurol Neurosci · Jan 2015
ReviewEvidence-Based Critical Care of Intracerebral Hemorrhage: An Overview.
Outcome of intracerebral hemorrhage (ICH) is still poor and siginificantly influenced by complications during the acute phase, so optimized neurocritical care is crucial. Vital parameters, neurological status and laboratory values of ICH-patient should be monitored very closely with special attention on blood pressure and intracranial pressure. ⋯ Neurosurgical treatment of ICH is still an individual decision. Patients with a higher level of consciousness may profit from an early operation.