Development Of Brain Swelling Research Articles

Clinical outcome prediction in aneurysmal subarachnoid hemorrhage - Alterations in brain-body interface.

Background:Brain–body associations are essential in influencing outcome in patients with ruptured brain aneurysms. Thus far, there is scarce literature on such important relationships.Methods:The multicenter Tirilazad database (3551 patients) was used to create this clinical outcome prediction model in order to elucidate significant brain–body associations. Traditional binary logistic regression models were used.Results:Binary logistic regression main effects model included four statistically significant single prognostic variables, namely, neurological grade, age, stroke, and time to surgery. Logistic regression models demonstrated the significance of hypertension and liver disease in development of brain swelling, as well as the negative consequences of seizures in patients with a history of myocardial infarction and post-admission fever worsening neurological outcome.Conclusions:Using the aforementioned results generated from binary logistic regression models, we can identify potential patients who are in the high risk group of neurological deterioration. Specific therapies can be tailored to prevent these detriments, including treatment of hypertension, seizures, early detection and treatment of myocardial infarction, and prevention of hepatic encephalopathy.

Bilateral near infrared spectroscopy in space-occupying middle cerebral artery stroke

The crucial importance of monitoring both the infarcted and non-infarcted hemispheres in management of space occupying middle cerebral artery (MCA) infarction is increasingly recognized, but optimal technique is debated. We investigated the potential for bilateral Near Infrared Spectroscopy (NIRS) to non-invasively provide relevant information on intracranial oxygenation. In patients with complete MCA stroke and brain swelling NIRS optodes were placed over both frontal lobes and regional cerebral oxygen saturation (rSO(2)) was measured at 30 s intervals for at least 12 h. The bilateral pattern of changes in rSO(2) was analysed with respect to clinical course and development of brain swelling, and patients compared according to outcome. A total of 24 patients were analysed, of whom 13 underwent decompressive hemicraniectomy; outcome was good (GOS > or = 3) in 11 cases, and poor (GOS < 3) in 13. Absolute rSO(2) values varied widely and did not correlate with clinical data. The average difference in rSO(2) (rSO(2)-diff) between infarcted and contralateral hemisphere was 10.7% and higher on the infarct side in 22/24 cases. The rSO(2)-diff typically decreased with brain swelling, disappeared in patients who developed herniation, but increased markedly after successful craniectomy and management of brain swelling. The rSO(2)-diff at the end of monitoring was significantly higher in good outcome survivors. The time pattern of rSO(2)-diff can be explained by alterations of perfusion and O(2)-consumption depending on hemispheric swelling. Bilateral NIRS may provide more useful information on cerebral oxygenation than unilateral measurements and its clinical validity to help predict worsening of brain swelling should be investigated further.

Current and future applications of magnetic resonance imaging and spectroscopy of the brain in hepatic encephalopathy

Hepatic encephalopathy (HE) is a common neuro-psychiatric abnormality, which complicates the course of patients with liver disease and results from hepatocellular failure and/or portosystemic shunting. The manifestations of HE are widely variable and involve a spectrum from mild subclinical disturbance to deep coma. Research interest has focused on the role of circulating gut-derived toxins, particularly ammonia, the development of brain swelling and changes in cerebral neurotransmitter systems that lead to global CNS depression and disordered function. Until recently the direct investigation of cerebral function has been difficult in man. However, new magnetic resonance imaging (MRI) techniques provide a non-invasive means of assessment of changes in brain volume (coregistered MRI) and impaired brain function (fMRI), while proton magnetic resonance spectroscopy (1H MRS) detects changes in brain biochemistry, including direct measurement of cerebral osmolytes, such as myoinositol, glutamate and glutamine which govern processes intrinsic to cellular homeostasis, including the accumulation of intracellular water. The concentrations of these intracellular osmolytes alter with hyperammonaemia. MRS-detected metabolite abnormalities correlate with the severity of neuropsychiatric impairment and since MR spectra return towards normal after treatment, the technique may be of use in objective patient monitoring and in assessing the effectiveness of various treatment regimens.

Cerebral edema and intracranial pressure monitoring.

With the wide acceptance of liver transplantation as a therapeutic alternative in fulminant hepatic failure (FHF), the successful management of patients with this syndrome has acquired a new urgency. Topping the list of medical problems is the development of brain swelling. Two decades after the recognition of its importance, brain edema and intracranial hypertension still constitute a major cause of death in these patients. In a more recent classification of FHF, brain edema was especially prominent in those subjects with "hyperacute failure," in whom a period of 7 days or less elapsed between the development of jaundice and encephalopathy. The goal of this review is to discuss two aspects of this clinical problem. On one hand, elucidation of its pathogenesis should lead to a more rational therapeutic approach; such an information would also be valuable to understand the relationship between hepatic encephalopathy and brain edema, a source of controversy. Studies of pathogenic mechanisms are difficult to perform in humans and animal models of FHF have proven valuable, as brain swelling can be detected with some regularity. On the other hand, an increasing array of techniques is now available in the intensive care setting to monitor patients with FHF. Of these, intracranial pressure monitoring has received the most critical attention. However, concerns with the risks of craniotomy and the need to acquire more dynamic information has led several groups to explore non-invasive methods that evaluate the consequences of intracranial hypertension. Their role, though potentially exciting, is still uncertain.

Paediatric head trauma: influence of age and sex. II. Biomechanical and anatomo-clinical correlations.

A consecutive, unselected series of 1812 cases of head trauma in children less than 15 years of age and admitted hospital over a period of 8.5 years was studied. Data concerning the grade of energy involved, the ages of the victims, the types of pathologies caused and the clinical features noted were collected and statistically analysed. Babies and toddlers (0-3 years) were shown to sustain rather low-energy trauma and suffer more skull fractures, more subdural haematomas and more benign injuries. They lost consciousness less frequently and were less frequently in coma than the other children. By contrast, they had more frequent signs of lateralization, and early seizures were much more frequent in babies than in other children. Young children (3-9 years) had rather higher-energy accidents, frequently lost consciousness, were more frequently in coma and have more frequently had a free interval associated with the development of brain swelling. They did not suffer subdural effusion or contrecoup lesions. Schoolchildren (9-15 years) were statistically more or less like young adults: the clinical sequences of trauma were more severe than in the other children, mortality was a little bit higher, the risk of extradural haematoma was higher, and they rarely suffered subdural haematomas or contrecoup lesions. Traffic accidents, with higher energy involved, were more severe.

Dynamics of posttraumatic brain swelling following a cryogenic injury in rats.

For evaluation of novel therapeutic regimens against brain edema in experimental models, it is important to know the temporal profile of edema formation. Since development of brain swelling and edema following a cryogenic injury is poorly documented in rats, these parameters have been investigated in this study. 17 Sprague-Dawley rats were used. Three rats (controls) were sham-operated. Their brains were removed 15 min after sham-operation. In all other animals a right parietal cryogenic lesion was applied in ketamine-xylazine anesthesia. Systemic blood pressure was monitored during the perioperative period. Brains were removed in defined intervals following cryogenic injury (0.25, 0.5, 1, 3, 6, 12, 24, and 72 h; n = 3 each). Hemispheres were then separated and weighed for determination of brain swelling, dried and weighed again. Cerebral water content was calculated as the difference of hemispheric wet- and dry-weight. Posttraumatic hemispheric swelling reached its maximum (7.9 +/- 0.4%) as early as 12 h post trauma. During the first hour after injury, brain swelling showed a steep, linear increase to 3.9%, i.e. swelling amounted to 50% of its maximum within one hour. 6 h post trauma swelling was 5.7%. After 12 h brain swelling started to decline. 72 h post cryogenic injury, 6.1% hemispheric swelling were found. Development of brain swelling was paralleled by a linear increase in brain water content of the lesioned hemisphere. The maximum of hemispheric water content was seen 24 h post trauma. In non-lesioned hemispheres only a marginal transient increase in cerebral water content was observed. edema has to be considered when planning therapeutic protocols.