Journal of neurology, neurosurgery, and psychiatry
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J. Neurol. Neurosurg. Psychiatr. · Jun 2004
Comparative StudyDoes the method of treatment of acutely ruptured intracranial aneurysms influence the incidence and duration of cerebral vasospasm and clinical outcome?
Cerebral vasospasm remains the leading cause of death and permanent disability after subarachnoid haemorrhage. This study determined whether the method of aneurysm treatment plays an important role in determining the incidence of cerebral vasospasm and its clinical consequences. ⋯ The treatment method had no influence on the incidence or duration of TCD detected vasospasm and there was no significant difference in outcome at discharge or follow up between those patients who had surgery or endovascular management of their aneurysms.
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J. Neurol. Neurosurg. Psychiatr. · Jun 2004
ReviewMonitoring and interpretation of intracranial pressure.
Intracranial pressure (ICP) is derived from cerebral blood and cerebrospinal fluid (CSF) circulatory dynamics and can be affected in the course of many diseases of the central nervous system. Monitoring of ICP requires an invasive transducer, although some attempts have been made to measure it non-invasively. Because of its dynamic nature, instant CSF pressure measurement using the height of a fluid column via lumbar puncture may be misleading. ⋯ Information which can be derived from ICP and its waveforms includes cerebral perfusion pressure (CPP), regulation of cerebral blood flow and volume, CSF absorption capacity, brain compensatory reserve, and content of vasogenic events. Some of these parameters allow prediction of prognosis of survival following head injury and optimisation of "CPP-guided therapy". In hydrocephalus CSF dynamic tests aid diagnosis and subsequent monitoring of shunt function.
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J. Neurol. Neurosurg. Psychiatr. · Jun 2004
Case Reports Comparative StudyDetection of cerebral perfusion abnormalities in acute stroke using phase inversion harmonic imaging (PIHI): preliminary results.
Phase inversion harmonic imaging (PIHI) with newer contrast agents can display parameters of cerebral perfusion either using the established ipsilateral approach, or the novel bilateral approach in which both hemispheres are assessed in one examination. The aim of this study was to evaluate the potential of PIHI in detecting pathological perfusion in acute stroke, using the bilateral approach. Patients with a hemispheric syndrome presenting within 12 hours after symptom onset were examined with PIHI (SonoVue; bolus kinetics, fitted model function) using the bilateral approach if possible. ⋯ Furthermore, in one case, a surrounding hypoperfused region was identified, where tissue survived after recanalisation of the initially occluded middle cerebral artery. Using the bilateral approach, two advantages in comparison with the ipsilateral approach were obvious: cortical structures could be evaluated, and only one examination was needed to compare unaffected (ipsilateral) with affected (contralateral) tissue. These results should be confirmed by more cases, and should also be correlated to acute perfusion/diffusion weighted MRI data.
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J. Neurol. Neurosurg. Psychiatr. · Jun 2004
Comparative StudyClinical and radiological predictors of recanalisation and outcome of 40 patients with acute basilar artery occlusion treated with intra-arterial thrombolysis.
To define predictors of recanalisation and clinical outcome of patients with acute basilar artery occlusions treated with local intra-arterial thrombolysis (IAT). ⋯ Low baseline NIHSS on admission and recanalisation of basilar artery occlusions predict a favourable outcome after intra-arterial thrombolysis. Early initiation of IAT and the presence of a hyperdense basilar artery sign on CT were associated with a higher likelihood of recanalisation.