- The currency, completeness and quality of systematic reviews of acute management of moderate to severe traumatic brain injury: A comprehensive evidence map. [Journal Article]
- PlosPLoS One 2018; 13(6):e0198676
- CONCLUSIONS: A substantial number of SRs in acute management of moderate to severe TBI lack currency, completeness and quality. We have identified both potential evidence gaps and also substantial research waste. Novel review methods, such as Living Systematic Reviews, may ameliorate these shortcomings and enhance utility and reliability of the evidence underpinning clinical care.
- Intracranial Hypotension and Hypertension Associated With Reconstructive Cranioplasty After Decompressive Craniectomy: Report of a Lethal Complication With Recommended Strategies for Future Avoidance. [Journal Article]
- JCJ Craniofac Surg 2018 Jun 20
- Reconstructive cranioplasty can be associated with many complications and add to the not insignificant potential risks associated with decompressive craniectomy. In the setting of post-traumatic hydr...
Reconstructive cranioplasty can be associated with many complications and add to the not insignificant potential risks associated with decompressive craniectomy. In the setting of post-traumatic hydrocephalus, treatment with a ventriculoperitoneal (VP) shunt prior to reconstructive cranioplasty likely increases these risks even further. The authors report a case of a 17-year-old male with a history of a severe closed head injury who initially suffered a life-threatening complication associated with intracranial hypotension after cranioplasty only to succumb to malignant intracranial hypertension following a second cranioplasty attempt. To our knowledge, this is the first description of a single patient developing both these disparate complications after reconstructive cranioplasty and emphasizes the likely synergistic hazards involved with decompressive craniectomy in the setting of a VP shunt in particular and the overall myriad potential complications that may be associated with reconstructive cranioplasty in general.
- [A favorable outcome of surgical treatment and intensive care in a child admitted in a severe condition in the setting of aneurysmal subarachnoid hemorrhage (a clinical case and literature review)]. [Journal Article]
- ZVZh Vopr Neirokhir Im N N Burdenko 2018; 82(3):66-72
- Treatment of children in the acute stage of hemorrhage from cerebral aneurysms is based on clinical cases reported in the literature and descriptions of small series of observations. There are no stu...
Treatment of children in the acute stage of hemorrhage from cerebral aneurysms is based on clinical cases reported in the literature and descriptions of small series of observations. There are no studies that enable the development of evidence-based approaches to intensive care in treatment of children with aSAH. We present a clinical case with a favorable outcome of complex treatment in a child admitted to the Burdenko Neurosurgical Institute at an extremely severe condition. The efficacy of treatment was based on a timely urgent neurosurgical intervention and adequate intensive therapy in the form of extended neuromonitoring with continuous measurement of intracranial pressure, which enabled using the whole complex of measures for timely management of intracranial hypertension. A favorable outcome (a GOS score IV) after this severe aneurysmal SAH indicates that there are no absolute contraindications for neurosurgical treatment of children with cerebral aneurysms.
- [Preoperative and postoperative ophthalmic symptoms in patients with space-occupying lesions of the midbrain and pineal region]. [Journal Article]
- ZVZh Vopr Neirokhir Im N N Burdenko 2018; 82(3):42-47
- CONCLUSIONS: Before surgery, oculomotor and pupil disorders were detected in more than half of the (67%) patients; ophthalmoscopic signs of intracranial hypertension were present in 38% of the patients. Neuro-ophthalmic symptoms significantly more often occurred in patients with malignant tumors. Midbrain symptoms were significantly more pronounced in germ cell tumors than in other malignant neoplasms. In the early postoperative period after tumor resection, deterioration of oculomotor and pupillary functions occurred in 46% of cases; there were no changes in 51% of cases; improvement occurred in 3% of cases. After tumor biopsy, symptoms in all patients with germinomas remained at the preoperative level. Developed symptoms partially regressed in the long-term period, and finally, only 29% of patients had deterioration of oculomotor and pupillary functions compared to the preoperative level.
- [Autoregulation of cerebral blood flow in severe diffuse axonal brain injury: the role of neuroanatomical factors]. [Journal Article]
- ZVZh Vopr Neirokhir Im N N Burdenko 2018; 82(3):5-14
- CONCLUSIONS: The obtained data may indicate the presence of central (neurogenic) pathways of cerebral vessel tone regulation; traumatic injury of the pathways leads to a more severe and prolonged period of impaired ACBF. Probably, injury to these regulatory structures in some patients has an indirect effect on the course of intracranial hypertension. Further experimental and clinical studies in this direction are needed to elucidate all elements of neurogenic regulation of cerebral vessel tone and ACBF mechanisms.
- Features of branch occlusive disease-type intracranial atherosclerotic stroke in young patients. [Journal Article]
- BNBMC Neurol 2018 Jun 20; 18(1):87
- CONCLUSIONS: BOD in young patients with ischemic stroke induced by intracranial atherosclerosis is not rare (33.3%) and its clinical manifestations and prognosis are similar to those of SAD. This may be related to the mild localized stenosis at the distal end in the M1 segment of MCA. Control of hypertension might play a positive role in secondary prevention.
- Chiari I malformation and basilar invagination in fibrous dysplasia: prevalence, mechanisms, and clinical implications. [Journal Article]
- JBJ Bone Miner Res 2018 Jun 20
- Fibrous dysplasia (FD) is a mosaic disorder of benign fibro-osseous lesions, which may be associated with extraskeletal features as part of McCune-Albright syndrome (MAS). Cranial base abnormalities,...
Fibrous dysplasia (FD) is a mosaic disorder of benign fibro-osseous lesions, which may be associated with extraskeletal features as part of McCune-Albright syndrome (MAS). Cranial base abnormalities, including Chiari I malformation (CM1), in which the cerebellum extends below the foramen magnum, and secondary basilar invagination (BI), in which the odontoid prolapses into the posterior cranial fossa, are potentially serious complications of metabolic bone disorders. The purpose of this study was to determine the prevalence, natural history, and risk factors for CM1 and BI in patients with FD/MAS, and to determine mechanisms of cranial base deformities. Clinical and radiographic data from subjects in an FD/MAS natural history study were evaluated and compared to normal controls. In 158 patients with craniofacial FD, 10 (6.3%) cases of CM1 and 12 (7.6%) cases of BI were diagnosed. No cranial base abnormalities were identified in 10 control subjects. Craniomorphometric and volumetric analyses identified cranial constriction and cranial settling as the primary mechanisms of cranial base abnormalities, while intracranial hypertension was a contributing factor in a minority of subjects. Longitudinal analyses found progression of odontoid position with age, but no progression of tonsillar position. No endocrinopathies were associated with CM1. MAS endocrinopathies associated with BI included hyperthyroidism (OR = 12.0, 95% confidence interval (CI) = 2.9-55.6; p < 0.01), precocious puberty (OR = 5.6, 95% CI = 1.2-26.0; p < 0.05), and hypophosphatemia (OR = 7.7, 95% CI = 1.9-27.0; p < 0.01). Scoliosis was associated with both CM1 (OR = 4.8, 95% CI = 1.1-22.8; p < 0.05) and BI (OR = infinity, 95% CI = 4.7- infinity; p < 0.01). This study successfully characterized cranial base abnormalities in FD/MAS and the pathophysiological connection between them. These findings support routine screening for cranial base abnormalities in patients with craniofacial FD, as well as aggressive management of contributory risk factors. This article is protected by copyright. All rights reserved.
- Hypertonic Lactate to Improve Cerebral Perfusion and Glucose Availability After Acute Brain Injury. [Journal Article]
- CCCrit Care Med 2018 Jun 19
- CONCLUSIONS: This is the first clinical demonstration that hypertonic lactate resuscitation improves both cerebral perfusion and brain glucose availability after brain injury. These cerebral vascular and metabolic effects appeared related to brain lactate supplementation rather than to systemic effects.
- Misled by the Air: Pneumocephalus. [Journal Article]
- CCureus 2018 Apr 14; 10(4):e2480
- Pneumocephalus, the presence of air within the cranium, commonly suggests a breach in the meningeal layer or an intracranial infection by a gas-producing organism. Trauma is the most common cause of ...
Pneumocephalus, the presence of air within the cranium, commonly suggests a breach in the meningeal layer or an intracranial infection by a gas-producing organism. Trauma is the most common cause of pneumocephalus, followed by cranial surgery. Other causes include infection and intracranial neoplasm. An 87-year-old man was conveyed to the emergency department after being found to be drowsy by his helper. He was noted to have a new onset right-sided hemiparesis. Past medical history was significant for hypertension, stage 5 chronic kidney disease, cerebrovascular accident, pacemaker insertion for sick sinus syndrome, transurethral resection of the prostate for benign prostatic hyperplasia, and pulmonary tuberculosis. Computed tomography (CT) of the brain revealed pneumocephalus with air within the dural venous sinuses. A facial bone CT that was performed to look for a fracture demonstrated a minimally displaced fracture of the lateral wall of the right maxillary sinus. There was an acute left middle cerebral artery territory infarct with a hemorrhagic conversion. Despite medical treatment, the patient demised one month after the initial presentation. Pneumocephalus is an uncommon finding, even in trauma. In the event that the clinical presentation cannot be explained by the mere presence of air within the cranium, another diagnosis ought to be sought. The delay in finding an alternative diagnosis and its management can be disastrous or even fatal.
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- Screening of Asymptomatic Intracranial Arterial Stenosis among High Risk Subjects: A Pilot Study from Egypt. [Journal Article]
- JVJ Vasc Interv Neurol 2018; 10(1):68-72
- CONCLUSIONS: This pilot study concluded that the prevalence of asymptomatic ICAS is relatively high in Egypt, and modifiable risk factors were the strongest predisposing factors of ICAS. TCD is an efficient non-invasive modality for the diagnostic evaluation of ICAS.