Neurological research
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In this study, we have reviewed our experience with anticoagulation-associated intraventricular hemorrhage (IVH). Our goal was to determine if IVH is also an independent prognosticator of fatal outcome in patients with anticoagulation-associated intracerebral hemorrhage (ICH). ⋯ Extension of anticoagulation-associated ICH into ventricular system caused a high mortality, especially in patients with panventricular involvement. IVH is an independent predictor of early death in these patients. In our experience, the majority of IVH do not expand over time and poor outcome appears to be related to the magnitude of the initial insult.
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Neurological research · Oct 2007
Monitoring of cerebral metabolism: non-ischemic impairment of oxidative metabolism following severe traumatic brain injury.
To investigate and compare the respective dynamics of cerebral blood flow (CBF) and metabolism in response to changes in neurological condition and intracranial pressure (ICP) in severe traumatic brain injury (TBI). ⋯ This study shows that cerebral metabolic failure following TBI is a common finding that is not of ischemic origin in most instances. Unlike frequently assumed, cerebral metabolism is not constrained within the narrow range of a static depression sustained for weeks but rather subject to significant variations in response to changes in ICP or neurological condition.
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Neurological research · Oct 2007
In-hospital delays to stroke thrombolysis: paradoxical effect of early arrival.
To determine the causes of in-hospital delays for thrombolysis. ⋯ An unexpected delay between order and actual initiation of i.v. tPA infusion resulted in almost one-third of patients receiving thrombolytics after 3 hours from symptom onset. The cause of this delay could not be discerned by this study. The paradoxical effect between early arrival to hospital and delayed treatment may be related to a sense of urgency in those arriving close to 3 hours after onset. Critical reviews such as this permit identification of hospital delays in stroke treatment, thus allowing institution of appropriate strategies to ensure prompt treatment.
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Neurological research · Oct 2007
Impact of hyperglycemia on neurological deficits and extracellular glucose levels in aneurysmal subarachnoid hemorrhage patients.
Hyperglycemia after aneurysmal subarachnoid hemorrhage (SAH) is associated with serious complications. Blood glucose may indicate a target for therapy to prevent delayed ischemic neurological deficits (DIND) and improve outcome. The objective of this study was to investigate energy metabolism in the extracellular/cerebrospinal fluid and blood in relation to outcome. ⋯ This study confirms the relevance of hyperglycemia to neurological outcome in SAH patients. Cerebral glucose was significantly lower in AFND patients despite hyperglycemic blood levels. More detailed works are necessary to select risk patients for optimized targeted therapy to avoid insulin-induced cerebral metabolic crisis.
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Neurological research · Oct 2007
ReviewA synopsis of brain pressures: which? when? are they all useful?
In addition to intracranial pressure (ICP) and cerebral perfusion pressure (CPP), there are many more brain-related measures defined as 'pressures'. Cerebral intra-tissue pressure, critical closing pressure, 'optimal' CPP, non-invasive CPP (nCPP) and non-invasive ICP (nICP), interhemispherical pressure gradients are the modalities which currently attract more attention in the management of head injured patients. ⋯ Most of the derived brain pressures cannot be assessed at the bedside without a dedicated computer tool. Some practical and theoretical aspects about the measurement, signal analysis, estimation process, accuracy and interpretation need further researching and refinement.