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Robbins E, Wong B, Pwint MY, Salavatian S, Mahajan A, Cui XT. Improving Sensitivity and Longevity of In Vivo Glutamate Sensors with Electrodeposited NanoPt. ACS APPLIED MATERIALS & INTERFACES 2024; 16:40570-40580. [PMID: 39078097 PMCID: PMC11310907 DOI: 10.1021/acsami.4c06692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/24/2024] [Accepted: 07/24/2024] [Indexed: 07/31/2024]
Abstract
In vivo glutamate sensing has provided valuable insight into the physiology and pathology of the brain. Electrochemical glutamate biosensors, constructed by cross-linking glutamate oxidase onto an electrode and oxidizing H2O2 as a proxy for glutamate, are the gold standard for in vivo glutamate measurements for many applications. While glutamate sensors have been employed ubiquitously for acute measurements, there are almost no reports of long-term, chronic glutamate sensing in vivo, despite demonstrations of glutamate sensors lasting for weeks in vitro. To address this, we utilized a platinum electrode with nanometer-scale roughness (nanoPt) to improve the glutamate sensors' sensitivity and longevity. NanoPt improved the GLU sensitivity by 67.4% and the sensors were stable in vitro for 3 weeks. In vivo, nanoPt glutamate sensors had a measurable signal above a control electrode on the same array for 7 days. We demonstrate the utility of the nanoPt sensors by studying the effect of traumatic brain injury on glutamate in the rat striatum with a flexible electrode array and report measurements of glutamate taken during the injury itself. We also show the flexibility of the nanoPt platform to be applied to other oxidase enzyme-based biosensors by measuring γ-aminobutyric acid in the porcine spinal cord. NanoPt is a simple, effective way to build high sensitivity, robust biosensors harnessing enzymes to detect neurotransmitters in vivo.
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Affiliation(s)
- Elaine
M. Robbins
- Department
of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States
| | - Benjamin Wong
- Department
of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States
- Department
of Anesthesiology & Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, United States
| | - May Yoon Pwint
- Department
of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States
- Center
for Neural Basis of Cognition, University
of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States
| | - Siamak Salavatian
- Department
of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States
- Department
of Anesthesiology & Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, United States
| | - Aman Mahajan
- Department
of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States
- Department
of Anesthesiology & Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, United States
| | - Xinyan Tracy Cui
- Department
of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States
- Center
for Neural Basis of Cognition, University
of Pittsburgh, Pittsburgh, Pennsylvania 15261, United States
- McGowan
Institute for Regenerative Medicine, University
of Pittsburgh, Pittsburgh, Pennsylvania 15261, United
States
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2
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Treichl SA, Ho WM, Steiger R, Grams AE, Rietzler A, Luger M, Gizewski ER, Thomé C, Petr O. Cerebral Energy Status and Altered Metabolism in Early Brain Injury After Aneurysmal Subarachnoid Hemorrhage: A Prospective 31P-MRS Pilot Study. Front Neurol 2022; 13:831537. [PMID: 35295831 PMCID: PMC8919991 DOI: 10.3389/fneur.2022.831537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background Acute changes of cerebral energy metabolism in early brain injury (EBI) after aneurysmal subarachnoid hemorrhage (aSAH) may play a crucial role for overall neurological outcome. However, direct detection of these alterations is limited. Phosphorous magnetic resonance spectroscopy (31P-MRS) is a molecular-based advanced neuroimaging technique allowing measurements of pathophysiological processes and tissue metabolism based on various phosphorous compound metabolites. This method may provide objective assessment of both primary and secondary changes. Objective The aim of this pilot study was to evaluate the feasibility and the diagnostic potential of early 31P-MRS in aSAH. Methods Patients with aSAH treated for ruptured aneurysms between July 2016 and October 2017 were prospectively included in the study. 3-Tesla-MRI including 31P-MRS was performed within the first 72 h after hemorrhage. Data of the vascular territories of the anterior, middle, and posterior cerebral arteries (ACA, MCA, PCA) and the basal ganglia were separately analyzed and compared with data of a healthy age- and sex-matched control group. Phosphorous compound metabolites were quantified, and ratios of these metabolites were further evaluated. Influence of treatment modality, clinical conditions, and analgosedation were analyzed. Results Data of 13 patients were analyzed. 31P-MRS showed significant changes in cerebral energy metabolism after aSAH in all cerebrovascular territories. Both PCr/ATP and PCr/Pi ratio were notably increased (P < 0.001). Also, Pi/ATP was significantly decreased in all cerebrovascular territories (P = 0.014). PME/PDE ratio was overall significant decreased (P < 0.001). Conclusion 31P-MRS is a promising non-invasive imaging tool for the assessment of changes in energy metabolism after aSAH. It allows a detailed insight into EBI and seems to harbor a high potential for clinical practice.
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Affiliation(s)
| | - Wing Mann Ho
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ruth Steiger
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
- *Correspondence: Ruth Steiger
| | - Astrid Ellen Grams
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Rietzler
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Luger
- Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke Ruth Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ondra Petr
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
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3
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Natile M, Simonet O, Vallot F, De Kock M. Ultrasound measurement of the optic nerve sheath diameter in traumatic brain injury: a narrative review. ACTA ANAESTHESIOLOGICA BELGICA 2021. [DOI: 10.56126/72.4.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background : Raised intracranial pressure (ICP) needs to be investigated in various situations, especially in traumatic brain injury (TBI). Ultra-sonographic (US) measurement of the optic nerve sheath diameter (ONSD) is a promising noninvasive tool for assessing elevated ICP.
Objectives : This narrative review aimed to explain the history of and indications forUS measurement of ONSD. We focused on the detection of elevated ICP after TBI and discussed the possible improvements in detection methods.
Conclusions : US measurement of ONSD in TBI cases provides a qualitative but no quantitative assessment of ICP. Current studies usually calculate their own optimum cutoff value for detecting raised ICP based on the balance between sensitivity and specificity of the method when compared with invasive methods. There is no universally accepted threshold. We did not find any paper focusing on the prognosis of patients benefiting from it when compared with usual care. Another limitation is the lack of standardization. US measurement of ONSD cannot be used as the sole technique to detect elevated ICP and monitor its evolution, but it can be a useful tool in a multimodal protocol and it might help to determine the prognosis of patients in various situations.
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4
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Dobrzeniecki M, Trofimov A, Martynov D, Agarkova D, Trofimova K, Semenova ZB, Bragin DE. Secondary Cerebral Ischemia at Traumatic Brain Injury Is More Closely Related to Cerebrovascular Reactivity Impairment than to Intracranial Hypertension. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 131:159-162. [PMID: 33839838 PMCID: PMC8109249 DOI: 10.1007/978-3-030-59436-7_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2024]
Abstract
The purpose of this study was to investigate the relationship between the development of secondary cerebral ischemia (SCI), intracranial pressure (ICP) and cerebrovascular reactivity (CVR) after traumatic brain injury (TBI). METHODS 89 patients with severe TBI with ICP monitoring were studied retrospectively. The mean age was 36.3 ± 4.8 years, 53 men, 36 women. The median Glasgow Coma Score (GCS) was 6.2 ± 0.7. The median Injury Severity Score was 38.2 ± 12.5. To specify the degree of impact of changes in ICP and CVR on the SCI progression in TBI patients, logistic regression was performed. Significant p-values were <0.05. RESULTS The deterioration of CVR in combination with the severity of ICP has a significant impact on the increase in the prevalence rate of SCI. A logistic regression analysis for a model of SCI dependence on intracranial hypertension and CVR was performed. The results of the analysis showed that CVR was the most significant factor affecting SCI development in TBI. CONCLUSIONS The development of SCI in severe TBI depends largely on CVR impairment and to a lesser extent on ICP level. Treatment for severe TBI patients with SCI progression should not be aimed solely at intracranial hypertension correction but also at CVR recovery.
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Affiliation(s)
- Michael Dobrzeniecki
- Department of Neurosurgery, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Alex Trofimov
- Department of Neurosurgery, Privolzhsky Research Medical University, Nizhny Novgorod, Russia.
| | - Dmitry Martynov
- Department of Neurosurgery, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Darya Agarkova
- Department of Neurosurgery, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Ksenia Trofimova
- Department of Neurosurgery, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Zhanna B Semenova
- Department of Neurosurgery, Children's Clinical and Research Institute of Emergency Surgery and Trauma, Moscow, Russia
| | - Denis E Bragin
- Lovelace Biomedical Research Institute, Albuquerque, NM, USA
- Department of Neurosurgery, University of New Mexico School of Medicine, 1 University of New Mexico, Albuquerque, NM, USA
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5
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de-Lima-Oliveira M, Ferreira AA, Belon AR, Salinet AM, Nogueira RC, Ping BC, Paiva WS, Teixeira MJ, Bor-Seng-Shu E. The influence of intracranial hypertension on static cerebral autoregulation. Brain Inj 2020; 34:1270-1276. [DOI: 10.1080/02699052.2020.1797166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | | | | | | | | | - Brasil Chian Ping
- Neurology Department, Hospital Das Clinicas Da FMUSP, Sao Paulo, Brazil
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6
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Forti RM, Katsurayama M, Menko J, Valler L, Quiroga A, Falcão ALE, Li LM, Mesquita RC. Real-Time Non-invasive Assessment of Cerebral Hemodynamics With Diffuse Optical Spectroscopies in a Neuro Intensive Care Unit: An Observational Case Study. Front Med (Lausanne) 2020; 7:147. [PMID: 32411712 PMCID: PMC7198738 DOI: 10.3389/fmed.2020.00147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 04/06/2020] [Indexed: 12/30/2022] Open
Abstract
Prevention of secondary damage is an important goal in the treatment of severe neurological conditions, such as major head trauma or stroke. However, there is currently a lack of non-invasive methods for monitoring cerebral physiology. Diffuse optical methods have been proposed as an inexpensive, non-invasive bedside monitor capable of providing neurophysiology information in neurocritical patients. However, the reliability of the technique to provide accurate longitudinal measurement during the clinical evolution of a patient remains largely unaddressed. Here, we report on the translation of a hybrid diffuse optical system combining frequency domain diffuse optical spectroscopy (FD-DOS) and diffuse correlation spectroscopy (DCS) for real-time monitoring of cerebral physiology in a neuro intensive care unit (neuro-ICU). More specifically, we present a case study of a patient admitted with a high-grade aneurysmal subarachnoid hemorrhage, who was monitored throughout hospitalization. We show that the neurophysiological parameters measured by diffuse optics at the bedside are consistent with the clinical evolution of the patient at all the different stages following its brain lesion. These data provide support for clinical translation of DOS/DCS as a useful biomarker of neurophysiology in the neuro-ICU, particularly in locations where other clinical resources are limited.
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Affiliation(s)
- Rodrigo M Forti
- Institute of Physics, University of Campinas, Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | - Marilise Katsurayama
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil.,Clinical Hospital, University of Campinas, Campinas, Brazil
| | - Julien Menko
- Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Lenise Valler
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil.,Clinical Hospital, University of Campinas, Campinas, Brazil
| | - Andres Quiroga
- Institute of Physics, University of Campinas, Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
| | | | - Li M Li
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil.,School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Rickson C Mesquita
- Institute of Physics, University of Campinas, Campinas, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, Campinas, Brazil
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7
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Forssten MP, Thelin EP, Nelson DW, Bellander BM. The Role of Glycerol-Containing Drugs in Cerebral Microdialysis: A Retrospective Study on the Effects of Intravenously Administered Glycerol. Neurocrit Care 2020; 30:590-600. [PMID: 30430381 PMCID: PMC6513829 DOI: 10.1007/s12028-018-0643-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cerebral microdialysis (CMD) is a valuable tool for monitoring compounds in the cerebral extracellular fluid (ECF). Glycerol is one such compound which is regarded as a marker of cell membrane decomposition. Notably, in some acutely brain-injured patients, CMD-glycerol levels rise without any other apparent indication of cerebral deterioration. The aim of this study was to investigate whether this could be due to an association between CMD-glycerol levels and the administration of glycerol-containing drugs. METHODS Microdialysis data were retrospectively retrieved from the hospital's intensive care unit patient data management system (PDMS). All patients who were monitored with CMD for ≥ 96 h were included. Administered drug doses were retrieved from the PDMS and converted to exact doses of glycerol. Cross-correlation analyses were performed between the free, metabolized as well as total administered dose of glycerol and the detrended and differenced CMD-glycerol concentration. These analyses were repeated for two sets of subgroups based upon the individual catheter's graphical trend and its location in relation to the lesion. RESULTS There was no significant correlation between the differenced CMD-glycerol levels and drug-administered glycerol. Furthermore, there was no significant correlation between CMD-glycerol and catheter location or graphical trend. However, if the CMD-glycerol levels were detrended, significant but clinically non-relevant correlations were identified (maximum correlation coefficient of 0.1 (0.04-0.15, 95% CI) at a lag of 7 h using the total administered dose of glycerol). CONCLUSIONS Glycerol-containing drugs routinely administered intravenously in the clinical setting appear to have a minimal and clinically insignificant effect on levels of glycerol in the cerebral ECF.
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Affiliation(s)
- Maximilian Peter Forssten
- Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| | - Eric Peter Thelin
- Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - David W Nelson
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Bo-Michael Bellander
- Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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8
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Zahra K, Gopal N, Freeman WD, Turnbull MT. Using Cerebral Metabolites to Guide Precision Medicine for Subarachnoid Hemorrhage: Lactate and Pyruvate. Metabolites 2019; 9:metabo9110245. [PMID: 31652842 PMCID: PMC6918279 DOI: 10.3390/metabo9110245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/09/2019] [Accepted: 10/22/2019] [Indexed: 12/20/2022] Open
Abstract
Subarachnoid hemorrhage (SAH) is one of the deadliest types of strokes with high rates of morbidity and permanent injury. Fluctuations in the levels of cerebral metabolites following SAH can be indicators of brain injury severity. Specifically, the changes in the levels of key metabolites involved in cellular metabolism, lactate and pyruvate, can be used as a biomarker for patient prognosis and tailor treatment to an individual’s needs. Here, clinical research is reviewed on the usefulness of cerebral lactate and pyruvate measurements as a predictive tool for SAH outcomes and their potential to guide a precision medicine approach to treatment.
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Affiliation(s)
- Kaneez Zahra
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.
| | - Neethu Gopal
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.
| | - William D Freeman
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.
- Department of Neurologic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.
| | - Marion T Turnbull
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.
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9
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Robbins EM, Jaquins-Gerstl A, Fine DF, Leong CL, Dixon CE, Wagner AK, Boutelle MG, Michael AC. Extended (10-Day) Real-Time Monitoring by Dexamethasone-Enhanced Microdialysis in the Injured Rat Cortex. ACS Chem Neurosci 2019; 10:3521-3531. [PMID: 31246409 DOI: 10.1021/acschemneuro.9b00145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Intracerebral microdialysis has proven useful for chemical monitoring in patients following traumatic brain injury. Recent studies in animals, however, have documented that insertion of microdialysis probes into brain tissues initiates a foreign-body response. Within a few days after probe insertion, the foreign body response impedes the use of microdialysis to monitor the K+ and glucose transients associated with spreading depolarization, a potential mechanism for secondary brain injury. Herein, we show that perfusing microdialysis probes with dexamethasone, a potent anti-inflammatory glucocorticoid, suppresses the foreign body response and facilitates the monitoring of spontaneous spreading depolarizations for at least 10 days following controlled cortical injury in the rat. In addition to spreading depolarizations, results of this study suggest that a progressive, apparently permanent, decline in pericontusional interstitial glucose may be an additional sequela of brain injury. This study establishes extended dexamethasone-enhanced microdialysis in the injured rodent cortex as a new paradigm for investigating trauma-induced metabolic crisis.
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Affiliation(s)
- Elaine M. Robbins
- Department of Chemistry, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
| | - Andrea Jaquins-Gerstl
- Department of Chemistry, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
| | - David F. Fine
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, United States
| | - Chi Leng Leong
- Department of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
| | - C. Edward Dixon
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, United States
| | - Amy K. Wagner
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, United States
| | - Martyn G. Boutelle
- Department of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
| | - Adrian C. Michael
- Department of Chemistry, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, United States
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10
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Bor-Seng-Shu E, de-Lima-Oliveira M, Nogueira RC, Almeida KJ, Paschoal EHA, Paschoal FM. Decompressive Craniectomy for Traumatic Brain Injury: Postoperative TCD Cerebral Hemodynamic Evaluation. Front Neurol 2019; 10:354. [PMID: 31031689 PMCID: PMC6473100 DOI: 10.3389/fneur.2019.00354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 03/22/2019] [Indexed: 12/31/2022] Open
Abstract
Background: There are no studies describing the cerebral hemodynamic patterns that can occur in traumatic brain injury (TBI) patients following decompressive craniectomy (DC). Such data have potentially clinical importance for guiding the treatment. The objective of this study was to investigate the postoperative cerebral hemodynamic patterns, using transcranial Doppler (TCD) ultrasonography, in patients who underwent DC. The relationship between the cerebral circulatory patterns and the patients' outcome was also analyzed. Methods: Nineteen TBI patients with uncontrolled brain swelling were prospectively studied. Cerebral blood circulation was evaluated by TCD ultrasonography. Patients and their cerebral hemispheres were categorized based on TCD-hemodynamic patterns. The data were correlated with neurological status, midline shift on CT scan, and Glasgow outcome scale scores at 6 months after injury. Results: Different cerebral hemodynamic patterns were observed. One patient (5.3%) presented with cerebral oligoemia, 4 patients (21%) with cerebral hyperemia, and 3 patients (15.8%) with cerebral vasospasm. One patient (5.3%) had hyperemia in one cerebral hemisphere and vasospasm in the other hemisphere. Ten patients (52.6%) had nonspecific circulatory pattern. Abnormal TCD-circulatory patterns were found in 9 patients (47.4%). There was no association between TCD-cerebral hemodynamic findings and outcome. Conclusion: There is a wide heterogeneity of postoperative cerebral hemodynamic findings among TBI patients who underwent DC, including hemodynamic heterogeneity between their cerebral hemispheres. DC was proved to be effective for the treatment of cerebral oligoemia. Our data support the concept of heterogeneous nature of the pathophysiology of the TBI and suggest that DC as the sole treatment modality is insufficient.
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Affiliation(s)
- Edson Bor-Seng-Shu
- Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, São Paulo University Medical School, São Paulo, Brazil
| | - Marcelo de-Lima-Oliveira
- Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, São Paulo University Medical School, São Paulo, Brazil
| | - Ricardo Carvalho Nogueira
- Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, São Paulo University Medical School, São Paulo, Brazil
| | - Kelson James Almeida
- Department of Neurology, Federal University of Piauí Medical School, Teresina, Brazil
| | | | - Fernando Mendes Paschoal
- Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, São Paulo University Medical School, São Paulo, Brazil.,Department of Neurology, Federal University of Pará Medical School, São Paulo, Brazil
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11
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Santos‐Teles AG, Passos RH, Panerai RB, Ramalho C, Farias S, Rosa JG, Gobatto A, Benigno P, Caldas JR. Intravenous administration of Milrinone, as an alternative approach to treat vasospasm in subarachnoid hemorrhage: A case report of transcranial Doppler monitoring. Clin Case Rep 2019; 7:648-652. [PMID: 30997055 PMCID: PMC6452455 DOI: 10.1002/ccr3.2034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/16/2018] [Accepted: 12/18/2018] [Indexed: 01/03/2023] Open
Abstract
This case illustrates the importance and potential of having TCD monitoring in intensive care. This easy-to-use, safe, low-cost, and bedside tool allows evaluation of the safety and feasibility of an alternative treatment of VSP in SCH and demonstrates the potential to avoid the use of angiography, a high cost, invasive procedure.
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Affiliation(s)
- Alex Goes Santos‐Teles
- Critical Care UnitHospital São RafaelSalvadorBrazil
- Escola Bahiana de Medicina e Saúde PúblicaSalvadorBrazil
| | | | - Ronney B. Panerai
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
- NIHR Leicester Biomedical Research CentreGlenfield HospitalLeicesterUK
| | | | | | - João G Rosa
- Critical Care UnitHospital São RafaelSalvadorBrazil
| | | | | | - Juliana Ribeiro Caldas
- Critical Care UnitHospital São RafaelSalvadorBrazil
- Escola Bahiana de Medicina e Saúde PúblicaSalvadorBrazil
- University of Salvador (UNIFACS)SalvadorBrazil
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12
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Abstract
PURPOSE OF REVIEW Neurophysiology is a complex network of cellular, electrical, and vascular systems which function to maximize neuronal functioning and brain performance. The brain exists in a closed system made up of parenchyma, cerebrospinal fluid, and blood with any increase in volume leading to a corresponding decrease in one of the components. Once these compensatory mechanisms are exhausted, there is a precipitous increase in the intracranial pressure leading to decreases in cerebral perfusion and resulting ischemia. The cerebral vasculature has significant control over the total volume of blood and regional flow throughout the brain via autoregulation. Through this process, blood flow is tightly regulated to prevent fluctuations and is coupled precisely with metabolic demand. Moreover, oxygen delivery and aerobic respiration are essential for proper brain functioning and can become deranged in various disease states leading to cellular injury and death. RECENT FINDINGS Ongoing trials have provided evidence that in addition to targeted therapy for intracranial pressure monitoring, optimizing brain tissue oxygenation and cerebral autoregulation may lead to improved clinical outcomes. An understanding of neurophysiology is not only essential for treating patients suffering from intracranial injury but also for the development of novel monitoring and therapeutic techniques.
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13
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The Effects of Induction and Treatment of Intracranial Hypertension on Cerebral Autoregulation: An Experimental Study. Neurol Res Int 2018; 2018:7053932. [PMID: 30046492 PMCID: PMC6036802 DOI: 10.1155/2018/7053932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/19/2018] [Accepted: 05/16/2018] [Indexed: 02/04/2023] Open
Abstract
Background This study aimed to analyse cerebral autoregulation (CA) during induction and treatment of intracranial hypertension (ICH) in an experimental model. Materials and Methods Landrace and Duroc piglets were divided into mild and severe ICH groups. Four or seven millilitres of saline solution was infused into paediatric bladder catheter inserted in the parietal lobe (balloon inflation). After 1.5 h, a 3% saline solution was infused via venous catheter, and 30 min later, the bladder catheter balloon was deflated (surgery). The cerebral static autoregulation (sCA) index was evaluated using cerebral blood flow velocities (CBFV) obtained with Doppler ultrasound. Results Balloon inflation increased ICP in both groups. The severe ICH group showed significantly lower sCA index values (p=0.001, ANOVA) after balloon inflation (ICH induction) and a higher sCA index after saline injection (p=0.02) and after surgery (p=0.04). ICP and the sCA index were inversely correlated (r=-0.68 and p<0.05). CPP and the sCA index were directly correlated (r=0.74 and p<0.05). Conclusion ICH was associated with local balloon expansion, which triggered CA impairment, particularly in the severe ICH group. Moreover, ICP-reducing treatments were associated with improved CA in subjects with severe ICH.
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14
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Microdialysis as a useful tool to detect cerebral metabolic crises. Acta Neurochir (Wien) 2018; 160:919-920. [PMID: 29450653 DOI: 10.1007/s00701-018-3484-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/01/2018] [Indexed: 10/18/2022]
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Akçıl EF, Dilmen ÖK, Vehid H, Tunalı Y. Can Amantadine Ameliorate Neurocognitive Functions After Subarachnoid Haemorrhage? A Preliminary Study. Turk J Anaesthesiol Reanim 2018; 46:100-107. [PMID: 29744244 PMCID: PMC5937455 DOI: 10.5152/tjar.2018.20280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/28/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Aneurysmal subarachnoid haemorrhage (SAH) may have devastating effects on patients. Motor and neurocognitive impairments may arise depending on the location and grade of the SAH. Although the effects of amantadine on neurocognitive function after traumatic brain injury have been widely studied to the best of our knowledge, their effects on recovery from SAH in humans have not been studied. The present study aimed to evaluate how amantadine influences improvement in neurocognitive function in patients with aneurysmal SAH over a period of six months. METHODS This preliminary study included 12 patients with aneurysmal SAH who were admitted to the neurointensive care unit of Cerrahpasa Faculty of Medicine. Patients in Group A (n=5) received the standard treatment for SAH and amantadine for 30 days after admission, and those in Group C (n=7) received only the standard treatment. Neurocognitive function was evaluated using the Coma Recovery Scale-Revised and Disability Rating Scale on the first and fifth days and at the third and sixth months after admission. The primary endpoint of the present study was to compare the effects of amantadine in combination with the standard treatment to those of the standard treatment alone on the neurocognitive function of patients with SAH for over 6 months. RESULTS Compared to the standard treatment alone, amantadine administration with the standard treatment during the early period of SAH may improve recovery. CONCLUSION Amantadine along with the standard treatment can ameliorate neurocognitive function after SAH.
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Affiliation(s)
- Eren Fatma Akçıl
- Department of Anesthesiology and Reanimation, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Özlem Korkmaz Dilmen
- Department of Anesthesiology and Reanimation, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Hayriye Vehid
- Department of Biostatistics, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Yusuf Tunalı
- Department of Anesthesiology and Reanimation, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
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Dash HH, Chavali S. Management of traumatic brain injury patients. Korean J Anesthesiol 2018; 71:12-21. [PMID: 29441170 PMCID: PMC5809702 DOI: 10.4097/kjae.2018.71.1.12] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 01/24/2018] [Accepted: 01/24/2018] [Indexed: 01/07/2023] Open
Abstract
Traumatic brain injury (TBI) has been called the ‘silent epidemic’ of modern times, and is the leading cause of mortality and morbidity in children and young adults in both developed and developing nations worldwide. In recent years, the treatment of TBI has undergone a paradigm shift. The management of severe TBI is ideally based on protocol-based guidelines provided by the Brain Trauma Foundation. The aims and objectives of its management are prophylaxis and prompt management of intracranial hypertension and secondary brain injury, maintenance of cerebral perfusion pressure, and ensuring adequate oxygen delivery to injured brain tissue. In this review, the authors discuss protocol-based approaches to the management of severe TBI as per recent guidelines.
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Affiliation(s)
- Hari Hara Dash
- Department of Anesthesiology and Pain Medicine, Fortis Memorial Research Institute, Gurgaon, India
| | - Siddharth Chavali
- Department of Neuroanesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Zeiler FA, Thelin EP, Helmy A, Czosnyka M, Hutchinson PJA, Menon DK. A systematic review of cerebral microdialysis and outcomes in TBI: relationships to patient functional outcome, neurophysiologic measures, and tissue outcome. Acta Neurochir (Wien) 2017; 159:2245-2273. [PMID: 28988334 PMCID: PMC5686263 DOI: 10.1007/s00701-017-3338-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 09/19/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To perform a systematic review on commonly measured cerebral microdialysis (CMD) analytes and their association to: (A) patient functional outcome, (B) neurophysiologic measures, and (C) tissue outcome; after moderate/severe TBI. The aim was to provide a foundation for next-generation CMD studies and build on existing pragmatic expert guidelines for CMD. METHODS We searched MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library (inception to October 2016). Strength of evidence was adjudicated using GRADE. RESULTS (A) Functional Outcome: 55 articles were included, assessing outcome as mortality or Glasgow Outcome Scale (GOS) at 3-6 months post-injury. Overall, there is GRADE C evidence to support an association between CMD glucose, glutamate, glycerol, lactate, and LPR to patient outcome at 3-6 months. (B) Neurophysiologic Measures: 59 articles were included. Overall, there currently exists GRADE C level of evidence supporting an association between elevated CMD measured mean LPR, glutamate and glycerol with elevated ICP and/or decreased CPP. In addition, there currently exists GRADE C evidence to support an association between elevated mean lactate:pyruvate ratio (LPR) and low PbtO2. Remaining CMD measures and physiologic outcomes displayed GRADE D or no evidence to support a relationship. (C) Tissue Outcome: four studies were included. Given the conflicting literature, the only conclusion that can be drawn is acute/subacute phase elevation of CMD measured LPR is associated with frontal lobe atrophy at 6 months. CONCLUSIONS This systematic review replicates previously documented relationships between CMD and various outcome, which have driven clinical application of the technique. Evidence assessments do not address the application of CMD for exploring pathophysiology or titrating therapy in individual patients, and do not account for the modulatory effect of therapy on outcome, triggered at different CMD thresholds in individual centers. Our findings support clinical application of CMD and refinement of existing guidelines.
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Affiliation(s)
- Frederick A. Zeiler
- Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3A 1R9 Canada
- Clinician Investigator Program, University of Manitoba, Winnipeg, Canada
- Department of Anesthesia, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
| | - Eric Peter Thelin
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
- Department of Clinical Neuroscience, Neurosurgical Research Laboratory, Karolinska University Hospital, Building R2:02, Karolinska Institutet, S-17176 Stockholm, Sweden
| | - Adel Helmy
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Marek Czosnyka
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
- Section of Brain Physics, Division of Neurosurgery, University of Cambridge, Cambridge, CB2 0QQ UK
| | - Peter J. A. Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - David K. Menon
- Department of Anesthesia, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
- Neurosciences Critical Care Unit, Addenbrooke’s Hospital, Cambridge, UK
- Queens’ College, Cambridge, UK
- National Institute for Health Research, Southampton, UK
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18
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Tao C, Hu X, Li H, You C. White Matter Injury after Intracerebral Hemorrhage: Pathophysiology and Therapeutic Strategies. Front Hum Neurosci 2017; 11:422. [PMID: 28890692 PMCID: PMC5575148 DOI: 10.3389/fnhum.2017.00422] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 08/04/2017] [Indexed: 02/05/2023] Open
Abstract
Intracerebral hemorrhage (ICH) accounts for 10%–30% of all types of stroke. Bleeding within the brain parenchyma causes gray matter (GM) destruction as well as proximal or distal white matter (WM) injury (WMI) due to complex pathophysiological mechanisms. Because WM has a distinct cellular architecture, blood supply pattern and corresponding function, and its response to stroke may vary from that of GM, a better understanding of the characteristics of WMI following ICH is essential and may shed new light on treatment options. Current evidence using histological, radiological and chemical biomarkers clearly confirms the spatio-temporal distribution of WMI post- ICH. Although certain types of pathological damage such as inflammatory, oxidative and neuro-excitotoxic injury to WM have been identified, the exact molecular mechanisms remain unclear. In this review article, we briefly describe the constitution and physiological function of brain WM, summarize evidence regarding WMI, and focus on the underlying pathophysiological mechanisms and therapeutic strategies.
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Affiliation(s)
- Chuanyuan Tao
- Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan UniversityChengdu, China
| | - Xin Hu
- Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan UniversityChengdu, China
| | - Hao Li
- Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan UniversityChengdu, China
| | - Chao You
- Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan UniversityChengdu, China
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[Intensive care treatment after aneurysmal subarachnoid hemorrhage]. Anaesthesist 2017; 65:951-970. [PMID: 27900416 DOI: 10.1007/s00101-016-0242-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Aneurysmal subarachnoid hemorrhage (SAH) is a devastating disease and nearly one third of patients die in the acute phase. Due to the bleeding event, a hyperactive sympathetic nervous system and an uncontrolled inflammatory response have a profound local and systemic impact on other organ functions. Neuroendocrinological disorders and cardiopulmonary morbidity are dominant. Despite a decrease in hospital mortality for high volume centers, a high proportion of survivors suffer from neurological deficits. Knowledge of the pathophysiology of vasospasms in the later stages of the disease has increased. Anti-inflammatory treatment does not improve the outcome. Nimodipine prophylaxis in the first 96 h after SAH seems to be the only intervention which has been proven to be advantageous in studies; however, nearly every second survivor of SAH suffers from some neurological deficits and more than one third of survivors report depressive episodes or symptoms of posttraumatic stress disorder.
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20
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Paschoal Jr FM, Nogueira RC, Ronconi KDAL, de Lima Oliveira M, Teixeira MJ, Bor-Seng-Shu E. Multimodal brain monitoring in fulminant hepatic failure. World J Hepatol 2016; 8:915-923. [PMID: 27574545 PMCID: PMC4976210 DOI: 10.4254/wjh.v8.i22.915] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 04/22/2016] [Accepted: 06/16/2016] [Indexed: 02/06/2023] Open
Abstract
Acute liver failure, also known as fulminant hepatic failure (FHF), embraces a spectrum of clinical entities characterized by acute liver injury, severe hepatocellular dysfunction, and hepatic encephalopathy. Cerebral edema and intracranial hypertension are common causes of mortality in patients with FHF. The management of patients who present acute liver failure starts with determining the cause and an initial evaluation of prognosis. Regardless of whether or not patients are listed for liver transplantation, they should still be monitored for recovery, death, or transplantation. In the past, neuromonitoring was restricted to serial clinical neurologic examination and, in some cases, intracranial pressure monitoring. Over the years, this monitoring has proven insufficient, as brain abnormalities were detected at late and irreversible stages. The need for real-time monitoring of brain functions to favor prompt treatment and avert irreversible brain injuries led to the concepts of multimodal monitoring and neurophysiological decision support. New monitoring techniques, such as brain tissue oxygen tension, continuous electroencephalogram, transcranial Doppler, and cerebral microdialysis, have been developed. These techniques enable early diagnosis of brain hemodynamic, electrical, and biochemical changes, allow brain anatomical and physiological monitoring-guided therapy, and have improved patient survival rates. The purpose of this review is to discuss the multimodality methods available for monitoring patients with FHF in the neurocritical care setting.
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de Lima Oliveira M, Bor-Seng-Shu E, Simm RF, Vilas Boas T, Pires Aguiar PH. Commentary: Systemic, Local, and Imaging Biomarkers of Brain Injury: More Needed, and Better Use of Those Already Established? Front Neurol 2016; 7:34. [PMID: 27047442 PMCID: PMC4800171 DOI: 10.3389/fneur.2016.00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/29/2016] [Indexed: 11/18/2022] Open
Affiliation(s)
- Marcelo de Lima Oliveira
- Neurology Department, Hospital Santa Paula, São Paulo, Brazil
- *Correspondence: Marcelo de Lima Oliveira,
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Galgano MA, Tovar-Spinoza Z. Multimodality Neuromonitoring in Pediatric Neurocritical Care: Review of the Current Resources. Cureus 2015; 7:e385. [PMID: 26719828 PMCID: PMC4689558 DOI: 10.7759/cureus.385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Brain insults in children represent a daily challenge in neurocritical care. Having a constant grasp on various parameters in the pediatric injured brain may affect the patient's outcome. Currently, new advances provide clinicians with the ability to utilize several modalities to monitor brain function. This multi-modal approach allows real-time information, leading to faster responses in management and furthermore avoiding secondary insults in the injured brain.
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de Lima Oliveira M, de Azevedo DS, de Azevedo MK, de Carvalho Nogueira R, Teixeira MJ, Bor-Seng-Shu E. Encephalic hemodynamic phases in subarachnoid hemorrhage: how to improve the protective effect in patient prognoses. Neural Regen Res 2015; 10:748-52. [PMID: 26109948 PMCID: PMC4468765 DOI: 10.4103/1673-5374.156969] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 11/23/2022] Open
Abstract
Subarachnoid hemorrhage is frequently associated with poor prognoses. Three different hemodynamic phases were identified during subarachnoid hemorrhage: oligemia, hyperemia, and vasospasm. Each phase is associated with brain metabolic changes. In this review, we correlated the hemodynamic phases with brain metabolism and potential treatment options in the hopes of improving patient prognoses.
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Affiliation(s)
- Marcelo de Lima Oliveira
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Daniel Silva de Azevedo
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Milena Krajnyk de Azevedo
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ricardo de Carvalho Nogueira
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Edson Bor-Seng-Shu
- Division of Neurological Surgery, Hospital das Clinicas, School of Medicine, University of São Paulo, São Paulo, Brazil
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Embolic signals during routine transcranial Doppler ultrasonography in aneurysmal subarachnoid hemorrhage. BIOMED RESEARCH INTERNATIONAL 2015; 2015:153714. [PMID: 25893190 PMCID: PMC4393888 DOI: 10.1155/2015/153714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/05/2015] [Accepted: 03/13/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Cerebral emboli may occur in subarachnoid hemorrhage (SAH) and intracranial aneurysm surgery. Although embolic signs (ES) have been reported in SAH, their origin remains unclear. The aim of this study was to report the detection of ES during routine TCD monitoring in patients with aneurysmal SAH. METHODS A total of 105 patients with aneurysmal SAH were submitted to TCD evaluation. Patients were monitored almost daily (5 times per week). In each monitoring session, one experienced operator performed TCD to detect or assess vasospasm and ES in arteries of the Willis polygon. RESULTS Four patients out of a total of 105 patients with aneurysmal SAH were found to present spontaneous cerebral embolization during routine TCD monitoring. The average age of the 4 patients (mean ± standard deviation) was 59.5 ± 8.34 years (range 49-68 ys); female patients predominated representing 75% (3/4) of subjects. CONCLUSION Although detection of ES was relatively rare in this study, rates of emboli occurrence may be higher under systematic monitoring. The detection of ES after SAH surgery reinforces the need to study the role of embolus in this condition and may be an indicator for prophylactic antithrombotic treatment.
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25
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Agoston DV. Bench-to-Bedside and Bedside Back to the Bench; Seeking a Better Understanding of the Acute Pathophysiological Process in Severe Traumatic Brain Injury. Front Neurol 2015; 6:47. [PMID: 25852631 PMCID: PMC4362297 DOI: 10.3389/fneur.2015.00047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/23/2015] [Indexed: 12/11/2022] Open
Abstract
Despite substantial investments, traumatic brain injury (TBI) remains one of the major disorders that lack specific pharmacotherapy. To a substantial degree, this situation is due to lack of understanding of the pathophysiological process of the disease. Experimental TBI research offers controlled, rapid, and cost-effective means to identify the pathophysiology but translating experimental findings into clinical practice can be further improved by using the same or similar outcome measures and clinically relevant time points. The pathophysiology during the acute phase of severe TBI is especially poorly understood. In this Mini review, I discuss some of the incongruences between current clinical practices and needs versus information provided by experimental TBI research as well as the benefits of designing animal experiments with translation into clinical practice in mind.
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Affiliation(s)
- Denes V Agoston
- Department of Anatomy, Physiology and Genetics, Uniformed Services University , Bethesda, MD , USA ; Department of Neuroscience, Experimental Neurotrauma, Karolinska Institutet , Stockholm , Sweden
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Abstract
Although neurocritical care as a subspecialty is a relatively young field of medicine, its origins can be traced back to ancient times. This article focuses on the progression of neurocritical care from prehistoric trepanation procedures, through the development of mechanical ventilation, management of increased intracranial pressure, and traumatic brain injury, to the establishment of the first "real" intensive care units, and finally to modern monitoring in neurocritical care, management of post-cardiac arrest patients, and the diagnosis of brain death. This article also focuses on the future direction of neurocritical care.
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Affiliation(s)
- Georgia Korbakis
- Department of Neurological Sciences, Rush University Medical Center, 600 South Paulina Street, Chicago, IL 60612, USA.
| | - Thomas Bleck
- Department of Neurological Sciences, Rush University Medical Center, 600 South Paulina Street, Chicago, IL 60612, USA; Department of Neurosurgery, Rush University Medical Center, 600 South Paulina Street, Chicago, IL 60612, USA; Department of Anesthesiology, Rush University Medical Center, 600 South Paulina Street, Chicago, IL 60612, USA; Department of Internal Medicine, Rush University Medical Center, 600 South Paulina Street, Chicago, IL 60612, USA
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de Lima Oliveira M, de Azevedo MK, Machado MF, Teixeira MJ, Bor-Seng-Shu E. The role of metabolism in the ischemia associated with vasospasm following brain tumor resection. J Neurointerv Surg 2014; 8:e17-9. [PMID: 24705735 DOI: 10.1136/neurintsurg-2014-011205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2014] [Indexed: 11/04/2022]
Affiliation(s)
- Marcelo de Lima Oliveira
- Division of Neurological Surgery, Hospital das Clinicas of S⭠Paulo University Medical School, São Paulo, Brazil
| | - Milena Krajnyk de Azevedo
- Division of Neurological Surgery, Hospital das Clinicas of S⭠Paulo University Medical School, São Paulo, Brazil
| | - Michel Ferreira Machado
- Division of Neurological Surgery, Hospital das Clinicas of S⭠Paulo University Medical School, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Division of Neurological Surgery, Hospital das Clinicas of S⭠Paulo University Medical School, São Paulo, Brazil
| | - Edson Bor-Seng-Shu
- Division of Neurological Surgery, Hospital das Clinicas of S⭠Paulo University Medical School, São Paulo, Brazil
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