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El-Gendy RS, El-Hamid ASA, Galhom AESA, Hassan NA, Ghoneim EM. Diagnostic dilemma of papilledema and pseudopapilledema. Int Ophthalmol 2024; 44:272. [PMID: 38916684 DOI: 10.1007/s10792-024-03215-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 06/16/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Papilledema is the optic disc swelling caused by increased intracranial pressure (ICP) that can damage the optic nerve and cause subsequent vision loss. Pseudopapilledema refers to optic disc elevation without peripapillary fluid that can arise from several optic disc disorders, with optic disc drusen (ODD) being the most frequent cause. Occasionally, pseudopapilledema patients are mistakenly diagnosed as papilledema, leading to the possibility of unneeded procedures. We aim to thoroughly examine the most current evidence on papilledema and pseudopapilledema causes and several methods for distinguishing between both conditions. METHODS An extensive literature search was conducted on electronic databases including PubMed and google scholar using keywords that were relevant to the assessed pathologies. Data were collected and then summarized in comprehensive form. RESULTS Various techniques are employed to distinguish between papilledema and pseudopapilledema. These techniques include Fundus fluorescein angiography, optical coherence tomography, ultrasonography, and magnetic resonance imaging. Lumbar puncture and other invasive procedures may be needed if results are suspicious. CONCLUSION Papilledema is a sight-threatening condition that may lead to visual affection. Many disc conditions may mimic papilledema. Accordingly, differentiation between papilledema and pseudopailledema is crucial and can be conducted through many modalities.
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Affiliation(s)
| | | | | | - Nihal Adel Hassan
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ehab Mahmoud Ghoneim
- Department of Ophthalmology, Faculty of Medicine, PortSaid University, PortSaid, Egypt
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Mathur R, Meyfroidt G, Robba C, Stevens RD. Neuromonitoring in the ICU - what, how and why? Curr Opin Crit Care 2024; 30:99-105. [PMID: 38441121 DOI: 10.1097/mcc.0000000000001138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
PURPOSE OF REVIEW We selectively review emerging noninvasive neuromonitoring techniques and the evidence that supports their use in the ICU setting. The focus is on neuromonitoring research in patients with acute brain injury. RECENT FINDINGS Noninvasive intracranial pressure evaluation with optic nerve sheath diameter measurements, transcranial Doppler waveform analysis, or skull mechanical extensometer waveform recordings have potential safety and resource-intensity advantages when compared to standard invasive monitors, however each of these techniques has limitations. Quantitative electroencephalography can be applied for detection of cerebral ischemia and states of covert consciousness. Near-infrared spectroscopy may be leveraged for cerebral oxygenation and autoregulation computation. Automated quantitative pupillometry and heart rate variability analysis have been shown to have diagnostic and/or prognostic significance in selected subtypes of acute brain injury. Finally, artificial intelligence is likely to transform interpretation and deployment of neuromonitoring paradigms individually and when integrated in multimodal paradigms. SUMMARY The ability to detect brain dysfunction and injury in critically ill patients is being enriched thanks to remarkable advances in neuromonitoring data acquisition and analysis. Studies are needed to validate the accuracy and reliability of these new approaches, and their feasibility and implementation within existing intensive care workflows.
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Affiliation(s)
- Rohan Mathur
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Geert Meyfroidt
- Department of Intensive Care Medicine, University Hospitals Leuven, Belgium and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Belgium
| | - Chiara Robba
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genova, Italy
| | - Robert D Stevens
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, USA
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Li M, Zhu R, Li G, Yin S, Zeng L, Bai Z, Chen J, Jiang B, Li L, Wu Y. Point-of-care testing for cerebral edema types based on symmetric cancellation near-field coupling phase shift and support vector machine. Biomed Eng Online 2023; 22:80. [PMID: 37582824 PMCID: PMC10428563 DOI: 10.1186/s12938-023-01145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 08/07/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Cerebral edema is an extremely common secondary disease in post-stroke. Point-of-care testing for cerebral edema types has important clinical significance for the precise management to prevent poor prognosis. Nevertheless, there has not been a fully accepted bedside testing method for that. METHODS A symmetric cancellation near-field coupling phase shift (NFCPS) monitoring system is established based on the symmetry of the left and right hemispheres and the fact that unilateral lesions do not affect healthy hemispheres. For exploring the feasibility of this system to reflect the occurrence and development of cerebral edema, 13 rabbits divided into experimental group (n = 8) and control group (n = 5) were performed 24-h NFCPS continuous monitoring experiments. After time difference offset and feature band averaging processing, the changing trend of NFCPS at the stages dominated by cytotoxic edema (CE) and vasogenic edema (VE), respectively, was analyzed. Furthermore, the features under the different time windows were extracted. Then, a discriminative model of cerebral edema types based on support vector machines (SVM) was established and performance of multiple feature combinations was compared. RESULTS The NFCPS monitoring outcomes of experimental group endured focal ischemia modeling by thrombin injection show a trend of first decreasing and then increasing, reaching the lowest value of - 35.05° at the 6th hour. Those of control group do not display obvious upward or downward trend and only fluctuate around the initial value with an average change of - 0.12°. Furthermore, four features under the 1-h and 2-h time windows were extracted. Based on the discriminative model of cerebral edema types, the classification accuracy of 1-h window is higher than 90% and the specificity is close to 1, which is almost the same as the performance of the 2-h window. CONCLUSION This study proves the feasibility of NFCPS technology combined with SVM to distinguish cerebral edema types in a short time, which is promised to become a new solution for immediate and precise management of dehydration therapy after ischemic stroke.
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Affiliation(s)
- Mingyan Li
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054 China
- College of Artificial Intelligence, Chongqing University of Technology, Chongqing, 401135 China
| | - Rui Zhu
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054 China
| | - Gen Li
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054 China
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, 400038 China
| | - Shengtong Yin
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054 China
| | - Lingxi Zeng
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054 China
| | - Zelin Bai
- College of Biomedical Engineering, Army Medical University, Chongqing, 400038 China
| | - Jingbo Chen
- College of Biomedical Engineering, Army Medical University, Chongqing, 400038 China
| | - Bin Jiang
- College of Artificial Intelligence, Chongqing University of Technology, Chongqing, 401135 China
| | - Lihong Li
- College of Artificial Intelligence, Chongqing University of Technology, Chongqing, 401135 China
| | - Yu Wu
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, 400054 China
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Sudakou A, Wabnitz H, Liemert A, Wolf M, Liebert A. Two-layered blood-lipid phantom and method to determine absorption and oxygenation employing changes in moments of DTOFs. BIOMEDICAL OPTICS EXPRESS 2023; 14:3506-3531. [PMID: 37497481 PMCID: PMC10368065 DOI: 10.1364/boe.492168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/29/2023] [Accepted: 05/29/2023] [Indexed: 07/28/2023]
Abstract
Near-infrared spectroscopy (NIRS) is an established technique for measuring tissue oxygen saturation (StO2), which is of high clinical value. For tissues that have layered structures, it is challenging but clinically relevant to obtain StO2 of the different layers, e.g. brain and scalp. For this aim, we present a new method of data analysis for time-domain NIRS (TD-NIRS) and a new two-layered blood-lipid phantom. The new analysis method enables accurate determination of even large changes of the absorption coefficient (Δµa) in multiple layers. By adding Δµa to the baseline µa, this method provides absolute µa and hence StO2 in multiple layers. The method utilizes (i) changes in statistical moments of the distributions of times of flight of photons (DTOFs), (ii) an analytical solution of the diffusion equation for an N-layered medium, (iii) and the Levenberg-Marquardt algorithm (LMA) to determine Δµa in multiple layers from the changes in moments. The method is suitable for NIRS tissue oximetry (relying on µa) as well as functional NIRS (fNIRS) applications (relying on Δµa). Experiments were conducted on a new phantom, which enabled us to simulate dynamic StO2 changes in two layers for the first time. Two separate compartments, which mimic superficial and deep layers, hold blood-lipid mixtures that can be deoxygenated (using yeast) and oxygenated (by bubbling oxygen) independently. Simultaneous NIRS measurements can be performed on the two-layered medium (variable superficial layer thickness, L), the deep (homogeneous), and/or the superficial (homogeneous). In two experiments involving ink, we increased the nominal µa in one of two compartments from 0.05 to 0.25 cm-1, L set to 14.5 mm. In three experiments involving blood (L set to 12, 15, or 17 mm), we used a protocol consisting of six deoxygenation cycles. A state-of-the-art multi-wavelength TD-NIRS system measured simultaneously on the two-layered medium, as well as on the deep compartment for a reference. The new method accurately determined µa (and hence StO2) in both compartments. The method is a significant progress in overcoming the contamination from the superficial layer, which is beneficial for NIRS and fNIRS applications, and may improve the determination of StO2 in the brain from measurements on the head. The advanced phantom may assist in the ongoing effort towards more realistic standardized performance tests in NIRS tissue oximetry. Data and MATLAB codes used in this study were made publicly available.
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Affiliation(s)
- Aleh Sudakou
- Nałęcz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
| | - Heidrun Wabnitz
- Physikalisch-Technische Bundesanstalt (PTB), Berlin, Germany
| | - André Liemert
- Institut für Lasertechnologien in der Medizin und Meßtechnik an der Universität Ulm, Germany
| | - Martin Wolf
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Adam Liebert
- Nałęcz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
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Vitt JR, Loper NE, Mainali S. Multimodal and autoregulation monitoring in the neurointensive care unit. Front Neurol 2023; 14:1155986. [PMID: 37153655 PMCID: PMC10157267 DOI: 10.3389/fneur.2023.1155986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/04/2023] [Indexed: 05/10/2023] Open
Abstract
Given the complexity of cerebral pathology in patients with acute brain injury, various neuromonitoring strategies have been developed to better appreciate physiologic relationships and potentially harmful derangements. There is ample evidence that bundling several neuromonitoring devices, termed "multimodal monitoring," is more beneficial compared to monitoring individual parameters as each may capture different and complementary aspects of cerebral physiology to provide a comprehensive picture that can help guide management. Furthermore, each modality has specific strengths and limitations that depend largely on spatiotemporal characteristics and complexity of the signal acquired. In this review we focus on the common clinical neuromonitoring techniques including intracranial pressure, brain tissue oxygenation, transcranial doppler and near-infrared spectroscopy with a focus on how each modality can also provide useful information about cerebral autoregulation capacity. Finally, we discuss the current evidence in using these modalities to support clinical decision making as well as potential insights into the future of advanced cerebral homeostatic assessments including neurovascular coupling.
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Affiliation(s)
- Jeffrey R. Vitt
- Department of Neurological Surgery, UC Davis Medical Center, Sacramento, CA, United States
- Department of Neurology, UC Davis Medical Center, Sacramento, CA, United States
| | - Nicholas E. Loper
- Department of Neurological Surgery, UC Davis Medical Center, Sacramento, CA, United States
| | - Shraddha Mainali
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States
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Abstract
OBJECTIVES Critically ill patients are at high risk of acute brain injury. Bedside multimodality neuromonitoring techniques can provide a direct assessment of physiologic interactions between systemic derangements and intracranial processes and offer the potential for early detection of neurologic deterioration before clinically manifest signs occur. Neuromonitoring provides measurable parameters of new or evolving brain injury that can be used as a target for investigating various therapeutic interventions, monitoring treatment responses, and testing clinical paradigms that could reduce secondary brain injury and improve clinical outcomes. Further investigations may also reveal neuromonitoring markers that can assist in neuroprognostication. We provide an up-to-date summary of clinical applications, risks, benefits, and challenges of various invasive and noninvasive neuromonitoring modalities. DATA SOURCES English articles were retrieved using pertinent search terms related to invasive and noninvasive neuromonitoring techniques in PubMed and CINAHL. STUDY SELECTION Original research, review articles, commentaries, and guidelines. DATA EXTRACTION Syntheses of data retrieved from relevant publications are summarized into a narrative review. DATA SYNTHESIS A cascade of cerebral and systemic pathophysiological processes can compound neuronal damage in critically ill patients. Numerous neuromonitoring modalities and their clinical applications have been investigated in critically ill patients that monitor a range of neurologic physiologic processes, including clinical neurologic assessments, electrophysiology tests, cerebral blood flow, substrate delivery, substrate utilization, and cellular metabolism. Most studies in neuromonitoring have focused on traumatic brain injury, with a paucity of data on other clinical types of acute brain injury. We provide a concise summary of the most commonly used invasive and noninvasive neuromonitoring techniques, their associated risks, their bedside clinical application, and the implications of common findings to guide evaluation and management of critically ill patients. CONCLUSIONS Neuromonitoring techniques provide an essential tool to facilitate early detection and treatment of acute brain injury in critical care. Awareness of the nuances of their use and clinical applications can empower the intensive care team with tools to potentially reduce the burden of neurologic morbidity in critically ill patients.
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Affiliation(s)
- Swarna Rajagopalan
- Department of Neurology, Cooper Medical School of Rowan University, Camden, NJ
| | - Aarti Sarwal
- Department of Neurology, Atrium Wake Forest School of Medicine, Winston-Salem, NC
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Near-infrared spectroscopy for intracranial hemorrhage detection in traumatic brain injury patients: A systematic review. Am J Emerg Med 2021; 50:758-764. [PMID: 34879500 DOI: 10.1016/j.ajem.2021.09.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/20/2021] [Accepted: 09/26/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To synthesize evidence of the use of near-infrared spectroscopy (NIRS) to detect intracranial hemorrhage in traumatic brain injury (TBI) patients. METHODS The literature search was conducted in PubMed and Google Scholar (from inception to July 2021). RESULTS 216 original articles were found, 197 of which were omitted, and the final review contained 19 original articles covering 2291 patients. CONCLUSION For patients with TBI, a NIRS test may be useful as a screening tool for intracranial hemorrhage, especially at the prehospital level. Negative results may help rule out intracranial hemorrhage and may remove the need for more head computed tomography (CT) scanning. Prehospital testing may guide the decision of whether the patient should be transferred to a craniotomy-equipped specialized hospital. NIRS can also be useful in situations when CT is not available. For future research, a significant objective is to show whether the effects of NIRS can improve outcomes and lead to meaningful improvements in clinical practice and decision making.
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