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At least 163 records · Page 9Linked to original sources

PubMed1987

Transcranial Doppler ultrasound for the assessment of intracranial arterial flow velocity--Part 2. Evaluation of intracranial arterial disease.

Transcranial (TC) pulsed Doppler ultrasound was used to evaluate flow velocity within the intracranial basal cerebral arteries in 71 patients with cerebrovascular disease as revealed by arteriography. Abnormalities of the fast-Fourier transformed (FFT) Doppler spectra were used to detect and classify obstructive lesions as well as dilative arteriopathy of the carotid siphon, the middle, anterior, and posterior cerebral arteries, and the basilar artery. Functional stenosis due to large shunting volumes in patients with arteriovenous malformations and in the presence of significant collateralization of extracranial obstructive lesions were similarly diagnosed.

Blood Flow Velocity↗

PubMed2006

Unruptured intracranial aneurysms: natural history and clinical management. Update on the international study of unruptured intracranial aneurysms.

In guiding treatment decisions for all patients with unruptured intracranial aneurysms, it is important to compare size-, site-, and group-specific natural history data with size-, site- and age-specific treatment morbidity and mortality data. Because patient age has a major effect on operative morbidity and mortality, but relatively little effect on natural history, surgical treatment of an UIA patient over age 50 and any treatment of UIA patients over age 70 should be considered with particular vigilance. Optimally, patients should be evaluated and treated at high-volume centers in a setting that emphasizes neurovascular teamwork and unbiased presentation and delivery of different therapeutic option, including the option of observation, which is often appropriate for patients with UIAs.

Age Factors↗

PubMed1981

Effect of pneumatic trousers on intracranial pressure in hypovolemic dogs with an intracranial mass.

Thirty-six dogs under chloralose anesthesia were studied in groups of six. Arterial pressure (BP), central venous pressure (CVP), intracranial pressure (ICP), and arterial blood gases were monitored. The group underwent: 1) anesthesia only; 2) phlebotomy (P) (40% of blood volume) and reinfusion (RI) of half the shed blood plus Ringer's lactate solution; 3) P followed by pneumatic trousers (PT), and then RI; 4) inflation of an epidural 2-cc Foley catheter (EFC); 5) P followed by EFC and then RI; and 6) P followed by EFC and then by PT and RI. Group 1 was stable. In Group 2, P lowered BP (49 torr systolic +/- 6 SEM), CVP, and ICP. RI restored these. In Group 3, the PT improved BP (P less than .05) without increasing ICP. In Group 4, EFC increased ICP (P less than .05) to 15 +/- 4 torr. In Groups 5 and 6, ICP was not significantly increased by EFC or PT and RI.

Animals↗

PubMed1989

Rebound surges of intracranial pressure as a consequence of forced ultrafiltration used to control intracranial pressure in patients with severe hepatorenal failure.

Cerebral edema remains the most common immediate cause of death in patients with fulminant hepatic failure. We have used ultrafiltration as a method of controlling intracranial pressure (ICP) when other measures have failed. Two cases in which an initial decrease in ICP was followed by a marked rebound increase resulting in death are reported.

Acetaminophen↗

PubMedDate not supplied

[Correlations between E.E.G. findings and intracranial pressure (ICP) during treatment of acute post-traumatic intracranial hypertension (preliminary report) (author's transl)].

An infusion of a 10% solution of Althesin was administered for treatment of acute post-traumatic intracranial hypertension. Six comatose patients, aged from 7 to 22 years, without neurosurgical lesions, were treated with doses of the compound varying from 40 to 400 ml per day for 1 to 6 days. Daily polygrahic recordings (E.E.G, E.M.G., E.K.G., respiration and I.C.P.) were made in all patients for periods of 4 to 8 hours. Doses lower than 0.12 ml/min. caused a slight reduction in I.C.P. in two patients, without variations in the E.E.G. Doses between 0.12 and 0.36 ml/min. provoked a reduction in I.C.P. in all patients, and the appearance of burst suppression in the E.E.G. in those patients with an "alternating" tracing only. Higher doses (0.36 to 0.72 ml/min.) caused a reduction in I.C.P. less than 50% in 5 of the 6 patients. Continuous slow wave tracings and border-line tracings showed less constant modifications. The reactivity of the I.C.P. and the E.E.G. to Althesin appears earlier and is more evident in patients with an alternating E.E.G. tracing and with pressure waves of the Lundberg type b. No side effects related to the use of barbiturates were noted after interrupting treatment.

Acute Disease↗

PubMed1991

Stable xenon does not increase intracranial pressure in primates with freeze-injury-induced intracranial hypertension.

Stable xenon (Xe)-enhanced computed tomography is a potentially valuable tool for high resolution, three-dimensional measurement of CBF in patients. However, reports that Xe causes cerebrovascular dilation and increases intracranial pressure (ICP) have tempered enthusiasm for its use. The effects of 5 min of 33% Xe inhalation on ICP (right and left hemispheres) were studied in eight fentanyl-anesthetized Rhesus monkeys after right-sided cortical freeze injury. ICP, CBF, and physiological variables were monitored for up to 6 h postinsult. The preinjury (control) right hemispheric ICP was 8 +/- 5 mm Hg (mean +/- SD) and left hemispheric ICP was 5 +/- 2 mm Hg. Postinjury observations were classified into low (less than 15 mm Hg) and high ICP (greater than or equal to 15 mm Hg) groups. Both right and left ICP values averaged 9 +/- 3 mm Hg in the low ICP group. In the high ICP group, the right ICP was 20 +/- 4 mm Hg and left ICP was 21 +/- 6 mm Hg. ICP was unchanged by Xe inhalation under control conditions as well as in both low and high ICP groups postinjury. Postinjury, the MABP decreased 10-15 mm Hg in the low ICP group and 10-17 mm Hg in the high ICP group 2-3 min after the start of Xe inhalation (p less than 0.05). These results show that 33% Xe inhalation does not increase ICP in fentanyl-anesthetized monkeys but could decrease MABP in stressed states, presumably because of the anesthetic effects of Xe.

Anesthesia↗

PubMed2004

Successful staged treatment for ruptured blister-like dissecting aneurysm of the intracranial internal carotid artery: acute GDC embolization for the blister-like aneurysm followed by proximal occlusion with extracranial-intracranial bypass in the chronic stage.

The surgical treatment of ruptured blister-like dissecting aneurysm on the internal carotid artery (ICA) is still controversial. We report a case of this disease successfully managed by a staged treatment: GDC packing into the blister-like aneurysm in the acute stage followed by proximal occlusion in the chronic stage. The merit of this staged treatment is to prevent rerupture in the acute stage and to allow the proximal occlusion in the chronic stage with or without an extracranial-intracranial bypass, after assessment of tolerance of the ICA occlusion.

Acute Disease↗

PubMed1990

[The effect of acetazolamide-induced, endogenous volume stress of the cerebrospinal system on intracranial pressure. Diamox--effect on intracranial pressure].

In 16 patients with possible disturbed CSF circulation longterm recording of intracranial pressure (ICP) was performed. In 9 of the 16 patients the disorder became evident after the application of an exogenous volume-pressure testing procedure. This procedure enabled a classification into a group I--disturbed CSF circulation (8 patients)--and another group II--normal CSF circulation (8 patients). During a routine Xenon-CT-CBF study all patients of both groups were given to 1 g acetazolamide (DIAMOX) intravenously. Before, during and after the administration of DIAMOX the epidural ICP was continuously measured. An increase in ICP was monitored in all patients. In group I the average initial ICP was 13.6 +/- 7.6 mmHg. The maximum ICP was reached within a time interval of 13.1 +/- 4.5 min after DIAMOX administration. At this time the mean ICP was 36.4 +/- 19.2 mmHg (p less than 0.01). The average initial ICP in group II was 6.3 +/- 4.2 mmHg. The maximum ICP was reached within a time interval of 13.6 +/- 1.1 min. At this time the mean ICP was 11.9 +/- 4.8 mmHg (p less than 0.01). In respect to the maximum ICP both groups were significantly different (p less than 0.01). Despite a considerably rising ICP up to values of about 50 to 70 mmHg in several patients of group I only 1 patient complained of being sick. Presumingly, an ICP elevation caused by vasodilatation would be better tolerated than ICP elevations due to other causes.

Acetazolamide↗

PubMed1989

Alteration of intracranial pressure, cerebral blood flow, autoregulation and carbondioxide-reactivity by hypotensive agents in baboons with intracranial hypertension.

Intracranial pressure (ICP) was recorded by epidural transducer and cisterna magna catheter, and regional cerebral blood flow (rCBF) using the intraarterial Xenon 133-technique were measured in baboons with normal and during increased ICP provoked by an inflatable balloon positioned subdurally. Arterial blood pressure was altered by controlled infusion of Sodium-nitroprusside (SNP), Nitroglycerine (NG) or Trimetaphan (TMP) with the aim of reducing blood pressure by about 20%. During exflated balloon SNP provoked an increase of ICP which was more prominent than with NG and TMP. During increased ICP (due to inflation of the balloon) again SNP led to a higher further increase of ICP than both NG and TMP. rCBF rose during the state of normal ICP when SNP was infused. This was not observed with infusion of NG or TMP. When ICP was increased again by inflation of the balloon all 3 substances reduced rCBF, indicating damage to the autoregulation. CO2-reactivity as measured by induced hyperventilation with reduction of arterial CO2-tension was affected by all 3 substances thus indicating impairment of vasoconstriction during increase of ICP and simultaneous decrease of blood pressure. However, this impairment of physiological vasoconstriction was more prominent with SNP than with NG and TMP. The results indicate that all 3 substances should be used with care to reduce blood pressure during surgery or under intensive care condition, particularly in patients with increased ICP.

Animals↗

PubMed2001

The Camino intracranial pressure sensor: is it optimal technology? An internal audit with a review of current intracranial pressure monitoring technologies.

OBJECTIVE: To audit the reliability of the Camino intracranial pressure (ICP) sensor (Camino Laboratories, San Diego, CA) in our clinical practice as part of a continuing quality assurance program, and to assess its relative usefulness as compared with currently available ICP monitoring technologies that we reviewed. DESIGN: Prospective audit of ICP device reliability and function in 50 patients with head injuries. METHODS: Zero drift was recorded immediately after the ICP device was removed from the patient. Dynamic frequency response bench testing of each functioning catheter from 0 to 30 Hz and static calibration testing from 0 to 100 mmHg during environmental temperature variation from 22 to 40 degrees C were carried out. RESULTS: Zero drift (range, -13 to 22 mmHg; median, -1 mmHg) was recorded immediately after the devices were removed from patients. Seventeen (50%) of the devices tested for zero drift had absolute drifts of at least 3 mmHg. There was no correlation between recorded zero drift and duration of monitoring (r = 0.154, P = 0.207). Five sensors (10% of those tested) failed during patient monitoring and were replaced. Static and dynamic calibration tests of the functioning sensors were within the manufacturer's specifications. However, the sensitivity of the devices to environmental temperature remains a problem. CONCLUSION: The Camino ICP sensor remains one of the most popular ICP monitoring devices for use in patients with traumatic brain injuries. However, our recent in-house assessment demonstrated the robustness of the device to be less than adequate during routine practice. In this study, more than 50% exhibited zero drift greater than 3 mmHg, which is unacceptable in a catheter tip ICP monitoring device in which zero drift and calibration cannot be checked in vivo. A review of the literature revealed that other available ICP monitoring devices may prove to be more reliable and thus more appropriate for routine clinical measurement of ICP.

Equipment Design↗

PubMed1974

Raised intracranial pressure and cerebral blood flow. 4. Intracranial pressure gradients and regional cerebral blood flow.

Intracranial pressure was raised by expansion of a supratentorial subdural ballon in anaesthetized baboons. Pressures were measured at several sites, both supratentorial and infratentorial, and cerebral blood flow was measured in each cerebral hemisphere separately. Pressures recorded from the right and left lateral ventricles corresponded closely throughout. Highly significant correlations were also obtained between the pressures in the right and left subdural spaces and the mean intraventricular pressure. There was, thus, no evidence of intracompartmental pressure gradients within the supratentorial space. Pressure gradients did, however, develop between the supratentorial and infratentorial compartments in the majority of experiments, although the level of supratentorial pressure at which this occurred, varied. Despite the presence of a large mass lesion over the right cerebral hemisphere, no significant differences developed between levels of cerebral blood flow in the two hemispheres, although flow in the right hemisphere remained consistently slightly lower than that in the left after the ballon was inserted.

Animals↗

PubMed1975

Raised intracranial pressure and cerebral blood flow. 5. Effects of episodic intracranial pressure waves in primates.

The effects of episodic waves of intracranial pressure on cerebral blood flow were studied in primates. Six pressure waves each of 20 minutes' duration and ranging from 50 to 100 mmHg in magnitude were induced in baboons, at intervals of 30 minutes, in an attempt to simulate clinical plateau waves. With pressure waves up to 75 mmHg, cerebral blood flow remained at control levels despite falling cerebral perfusion pressures. Between the initial pressure waves a marked hyperaemia developed, with cerebral blood flow increasing by as much as 100%, and this appeared to be a means whereby adequate flow was maintained during pressure waves. Later pressure waves, up to 100 mmHg, eventually reduced blood flow below control levels, although moderately high flows were maintained during periods of very low perfusion pressure. Brain metabolism was affected by eht episodic pressure waves, although no consistent change was seen.

Acetoacetates↗

PubMed1995

Illi intracranial pressure monitoring and fixation device. A new fixation system for intracranial pressure monitoring in children and adolescents in paediatric neurotraumatology, hydrocephalus and craniofacial surgery.

Fixation and positioning of intracranial pressure (ICP) monitoring devices in small children with very thin skull bones pose serious problems. We present a new ICP fixation device with two movable components compressing the skull bone from in- and outside. This new fixation system, designed by PD Dr. O.E. Illi and licensed by White Spot AG, Surgical Tools and Research, Baar, Switzerland, guarantees far greater stability and reliability than conventional screws or bolts. It is fully compatible with a range of fiberoptic or pneumatic transducer systems. We have applied this new device successfully in 10 patients.

Adolescent↗

PubMed2002

Intracranial-to-intracranial vascular anastomosis created using a microanastomotic device for the treatment of distal middle cerebral artery aneurysms. Technical note.

The use of a microanastomotic device for direct connection of intracranial vessels can be helpful to facilitate removal of distally located middle cerebral artery (MCA) aneurysms. The authors report on two patients who presented for treatment with large aneurysms distally located on the MCA. The aneurysms were completely excised and the proximal and distal portions of the parent vessel were connected in an end-to-end fashion by using a microanastomotic device. The time required to crossclamp the vessel for excision of the aneurysm and primary anastomosis was 10 minutes in one case and 15 minutes in the other. The short crossclamp time and high-quality anastomosis afforded by this device may be useful in the treatment of these difficult lesions and the prevention of cerebral ischemia.

Anastomosis, Surgical↗

PubMed1986

Evaluation of intracranial pressure rebound after evacuation of intracranial expanding lesions. An experimental study in dogs.

Sequential magnetic resonance imaging was used to follow brain displacement, signs of herniation and increase in local brain tissue water content during expansion and after evacuation of an extradural balloon in anesthetized, artificially ventilated dogs. A fatal intracranial pressure (ICP) rebound occurred if the cerebral perfusion pressure (CPP) was critically reduced to 20 mm Hg for more than half an hour. Despite reduction of brain displacement after balloon evacuation brain water content continued to increase. Compression of CSF outflow pathways and signs of herniation remained. CPP continuously fell to zero. ICP rebound is a grave situation significantly influenced by a large increase in brain tissue water.

Animals↗

PubMed1985

Experimental carbon dioxide laser brain lesions and intracranial dynamics: Part 1. Effect on intracranial pressure, systemic arterial pressure, central venous pressure, electroencephalography, and gross pathology.

Experimental brain lesions were created in the left parietooccipital cortex of the albino rabbit through the intact dura mater with high radiating carbon dioxide laser energy (40-watt impacts of 0.5-second duration for a total of 4 seconds on a 12.5-mm surface). Behavior, intracranial pressure (ICP), systolic arterial pressure (SAP), central venous pressure (CVP), electroencephalography (EEG), and gross pathology were studied at 2, 6, and 24 hours after the insult at a constant PaCO2 (38-42 torr). Disruption of the blood-brain barrier (Evans blue extravasation) was uniformly seen extending from the impact crater into the surrounding white matter in all groups. The ICP was elevated in sham-operated animals at 2 hours after the impact, and it remained elevated at 6 and 24 hours. The EEG revealed severe slowing with high voltage waves in the insulted left hemisphere. There was no change in mean SAP or CVP when compared to the sham-operated group. In the dexamethasone-pretreated group, there was a reduction of ICP when compared to the untreated group at 24 hours after the insult (P less than 0.005), but no changes in the gross pathology were noted.

Animals↗

PubMed1984

Multiple intracranial meningiomas associated with intracranial arterial aneurysm.

This report illustrates a patient who was found to harbor eight separate meningiomas associated with an intracranial arterial aneurysm. Five of the meningiomas were extirpated and the aneurysm was wrapped. The causality between multiple meningiomas and aneurysm is obscure. Although the introduction of CT has facilitated the diagnosis of multiple meningiomas there are however areas especially in the base of the skull and high parasagittally where small meningiomas may remain undetected.

Adult↗

PubMed1982

[Intracranial pressure pulse waveform: considerations about its origin and methods of estimating intracranial pressure dynamics].

Epidural pulse waveform is important as an indicator of intracranial pressure (ICP) dynamics. In this study, the origin of epidural pulse and the clinical implication of its waveform were investigated, using anesthetized artificially ventilated dogs. For this purpose, a cortical artery and a vein were cannulated, and the pressures were recorded simultaneously with epidural pressure (EDP), epidural pulse waveform (EDP-WF), systemic arterial pressure measured in a carotid artery (SAP), central venous pressure (CVP) and electrocardiogram. EDP-WF is composed of several initial peaks and a small delayed peak on the descending limb. The former peaks were slightly delayed from the SAP pulse and were synchronous with the cortical arterial pulse. The latter peak was synchronous with the atrial "a" wave on CVP, but not with the cortical venous pulse. Moreover, the cortical venous pulse was quite similar to EDP-WF. These findings indicate that the pulsation of the brain may be generated by the pulsatile arterial blood flow into the brain, which also affected the pulsation of the cortical vein. The latter peak which was considered to be of venous origin may reflect the dynamics of venules in the brain, not of the cortical vein. Increase of ICP by constant inflation of the epidural balloon or inhalation of CO2 cause EDP-WF monotonous. It is possible that the transmission of arterial pulse into the brain was augmented because of the tightness of the brain or decrease of cerebral vascular tone, although the cortical arterial pressure was not significantly changed or was even slightly decreased. Using a bolus injection technique, the change of EDP-WF in cats was compared with volume-pressure response (VPR) and pulse pressure (PP) which are reported to be good indicators for ICP dynamics. At about 30mmHg, EDP-WF became monotonous while VPR or PP showed only linear relationships with EDP up to 50 to 60 mmHg. Therefore EDP-WF may provide useful information about ICP dynamics in a relatively lower pressure range which could not be detected by VPR or PP study.

Animals↗