Articles: brain-injuries.
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To avoid ischaemic secondary insults after severe head injury (SHI) it would be helpful to know the relationship between cerebral perfusion pressure (CPP) and intracranial pressure (ICP). Static cerebrovascular autoregulation (AR) was tested in 14 patients after SHI. Mean arterial pressure (MAP) was varied to detect changes in intracranial pressure (ICP) indicative of intact AR. ⋯ Lower AR breakpoints were seen from 60 to 80 mmHg CPP, upper breakpoints were as high as 112. CPP monitoring achieves a twofold utility in targeted therapy: (1) defining the range of intact AR; and (2) lower AR breakpoint assessment to avoid secondary insults. Although the precise relationship between pAR breakpoints and the adequacy of cerebral perfusion to meet metabolic needs remains unclear, a technique such as described here is simple and has much to offer in targeting therapy toward specific pathophysiological processes in traumatic brain injury.
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J. Cereb. Blood Flow Metab. · Apr 2000
Expression of Fas and Fas ligand after experimental traumatic brain injury in the rat.
Apoptotic cell death plays an important role in the cascade of neuronal degeneration after traumatic brain injury (TBI), but the underlying mechanisms are not fully understood. However, increasing evidence suggests that expression of Fas and its ligand (FasL) could play a major role in mediating apoptotic cell death in acute and chronic neurologic disorders. To further investigate the temporal pattern of Fas and FasL expression after experimental TBI in the rat, male Sprague Dawley rats were subjected to unilateral cortical impact injury. ⋯ These results reveal induction of Fas and FasL expression in the cortex after TBI in the rat. Further, these data implicate an involvement of Fas and FasL in the pathophysiologic mechanism of apoptotic neurodegeneration after TBI. Last, these data suggest that strategies aimed to repress posttraumatic Fas- and FasL-induced apoptosis may open new perspectives for the treatment of TBI.
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Curr. Opin. Pediatr. · Apr 2000
ReviewCerebral hypothermia for prevention of brain injury following perinatal asphyxia.
The possibility that hypothermia has a therapeutic role during or after resuscitation from severe perinatal asphyxia has been a longstanding focus of research. Early studies using short periods of cooling had limited and contradictory results. ⋯ These encouraging results must be balanced against the well-known adverse systemic effects of hypothermia. Randomized clinical trials are in progress to test the safety and efficacy of cerebral hypothermia.
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Neurological research · Apr 2000
ReviewA neuromodulation strategy for rational therapy of complex brain injury states.
We review initial efforts at neuromodulation in the vegetative state and organize several aspects of recent studies of the underlying neurobiology of catastrophic brain injuries. An innovative strategy for patient and target selection for neuromodulation of impaired cognitive function is outlined. Scientific and ethical issues that will attend future efforts to appropriately risk-stratify patients and initiate interventions with therapeutic intent are considered.
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Ann Fr Anesth Reanim · Apr 2000
Review[Management of severe head injuries during the first 24 hours, in the emergency department, in neurosurgery].
In France, the role of the neurosurgeon in the emergency department depends on local health care policies and geographical constraints. Some departments include a neurosurgical team with a dedicated operating room. In others, a neurosurgeon can be reached by phone, possibly with an image transfer. ⋯ The management of a haematoma of the posterior fossa or a bleeding dural venous sinus would be difficult for a surgeon not qualified in neurosurgery. The optimal situation is the presence of a neurosurgeon in the medical team admitting patients with a severe head or spine trauma, for assessment of the neurological status, or interpretation of radiological explorations, insertion of an intracranial pressure monitoring device. Besides the extradural haematoma, other injuries such as an acute subdural haematoma, a haematoma associated with a contusion, an acute hydrocephalus, a depressed fracture of the skull, or a craniocerebral wound, also require an emergency decompressive procedure.