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 10,007 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper describes some major implications of brain insult following trauma or intracerebral haemorrhage for the development of brain oedema and compromised microcirculation. Secondary insults such as an increase in intracranial pressure and development of contusion and penumbra zone areas, as well as their bearing on outcome, are discussed. A therapeutic protocol is presented which aims at keeping intracranial volume within acceptable limits by counteraction of interstitial brain oedema, reduction in intracerebral blood volume, and improvement of microcirculation around contusions. This ICP-targeted therapy, called the "Lund Concept", for treatment of severe head injury has resulted in marked reduction in mortality following brain trauma.
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PMID:Pathophysiology of brain insult. Therapeutic implications with the Lund Concept. 1109 56

There is at present no clear indication for surgical removal of intracerebral haemorrhage (ICH) in the majority of patients. With deterioration from an initially good level of consciousness, many surgeons would agree that removal is life saving. The question is whether or not surgical removal of clot improves the ultimate outcome in patients who are stable or even improving. Improvement in function is based on the concept of a penumbra around an ICH. There is now mounting evidence that there is a penumbra of functionally impaired, but potentially reversible, neuronal injury surrounding a haematoma. A pro-active approach must, therefore, be maintained in the management of these patients to salvage as much of this brain as possible. Alert patients with small (< 2 cm) haematomas and moribund patients with extensive haemorrhage may not require surgical evacuation. Indications for clot removal in patients between these extremes are controversial. Current practice favours surgical intervention in the following situations: (i) superficial haemorrhage; (ii) clot volume between 20-80 ml; (iii) worsening neurological status; (iv) relatively young patients; (v) haemorrhage causing midline shift/raised ICP; and (vi) cerebellar haematomas > 3 cm or causing hydrocephalus. A large multicentre prospective randomised controlled trial (International Surgical Trial in Intracerebral Haemorrhage) is currently underway to determine if early clot evacuation will lead to a better neurological outcome in patients with spontaneous supratentorial, non-aneurysmal ICH.
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PMID:Surgical treatment of intracerebral haemorrhage. 1109 93

Jugular venous oxygen saturation (SvjO(2)) monitoring has been developed in order to detect cerebral ischaemia. The interpretation of SvjO(2) values remains nevertheless complex, and should be associated with cerebral haemodynamic multimonitoring with ICP and transcranial Doppler. With the hypothesis of a constant cerebral oxygen consummation, and also with a constant haematocrit, SvjO(2) variations correlates with cerebral blood flow variations. After a brain trauma, an SvjO(2)<50% or>75% is associated with a bad prognosis. To maintain SvjO(2)>50% constitutes a reasonable therapeutic objective, but the benefice associated with such a strategy has not been validated. Oxygen partial pressure (PtiO(2)) in the brain parenchyma may be monitored in the non-lesioned area (usually frontal) in order to detect a global cerebral ischaemia, or in the penumbra of a cerebral lesion in order to detect a local ischaemia. The values associated with an ischemic risk are not fully defined and may be under 10-15 mmHg. A concomitant metabolic monitoring by cerebral microdialysis is of importance to fully address the real cerebral local ischaemic burden. Scientific studies are mainly focused on patients with a brain traumatism. Nor SvjO(2), nor PtiO(2) monitoring have at present been demonstrated to be associated with a clinical benefit, and their use should be restricted to scientific research.
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PMID:[Monitoring of cerebral oxygenation with SvjO(2) or PtiO(2)]. 1681 65

Traumatic brain injury (TBI) and ischemic stroke cause a variable disruption of ionic homeostasis and massive ionic fluxes with subsequent osmotic water movement across the cells that causes edema, brain swelling, and deformation of the damaged tissue. Although cerebral microdialysis (CMD) has been used to study the brain neurochemistry, the ionic profiles of brain interstitial space fluid have rarely been reported in humans. We studied the ionic profile in injured areas of the brain by using CMD. As a control group, we included seven patients who had undergone surgical treatment of posterior fossa lesions, without abnormalities in the supratentorial compartment. Inductively coupled plasma mass spectrometry (ICP-MS) was used for ion determination. No significant differences were found in the [Na+]o, [K+]o, and [Cl-]o between normal injured brains and controls. The ionic profile of the ischemic core was characterized by very high [K+]o and an increase in [Na+]o, whereas [Cl-]o was linearly related to [Na+]o. In the traumatic core (TC), significantly higher levels of [Na+]o, [Cl-]o, and [K+]o were found. The main finding in the penumbra was a completely normal ionic profile for [Na+]o and [K+]o in 60% of the samples. ICP-MS coupled to ionic assays creates a powerful tool for a better understanding of the complex ionic disturbances that occur after severe TBI and ischemic stroke.
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PMID:Characterization of the Ionic Profile of the Extracellular Space of the Injured and Ischemic Brain: A Microdialysis Study. 2722 Sep 51