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Karuta SCV, Folchini CM, Fachi MM, Okumura LM, Manços GDR, Ricieri MC, Motta FA, Maeda AK. Observational study of intracranial compliance analysis in neurologically healthy pediatric patients using a non-invasive device. Sci Rep 2024; 14:19482. [PMID: 39174627 PMCID: PMC11341783 DOI: 10.1038/s41598-024-69938-8] [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: 11/22/2023] [Accepted: 08/12/2024] [Indexed: 08/24/2024] Open
Abstract
Information about the morphology of the intracranial pressure waveform, as well as the variations in intracranial pressure (ICP) and compliance in pediatric patients are essential to diagnose and predict the progression of various neurological conditions. However, there is no information on the morphology of the IP waveform in neurologically healthy pediatric patients. In the present study, intracranial compliance was therefore analyzed in neurologically healthy patients with the aid of a noninvasive device. The study was an observational, cross-sectional study. Fifty-five neurologically healthy participants were included. Data on intracranial compliance with the patient in two positions, lying down (0°) and seated (45°), were collected with a noninvasive extracranial sensor, which allowed the intracranial pressure waveforms to be recorded. The values of the ratio P2/P1 were then analyzed. A questionnaire (with a scale from zero to ten, where ten corresponds to the highest level of satisfaction) was applied for patients to evaluate their satisfaction with the sensor. Patients were 10 years old (average), and most of them were (58%). Mean P2/P1 ratio was 0.94 (sd = 0.14) in the supine position and 0.91 (sd = 0.15) in the seated position. Participants were satisfied with the length of time for which the equipment was used (9.8, sd = 0.71). The device did not cause any discomfort. The noninvasive method used was well accepted by the patients. Intracranial compliance values were determined by analysis of the P2/P1 ratio in neurologically healthy pediatric population.Trial registration: Brazilian Registry of Clinical Trials Identifier: RBR-5j74ddg.
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Affiliation(s)
- Simone Carreiro Vieira Karuta
- Department of Medicine Course, Pequeno Príncipe Faculdades, Curitiba, Paraná, Brazil.
- Department of Neurology, Hospital Pequeno Príncipe, Curitiba, PR, Brazil.
- Department of Clinical Research, Hospital Pequeno Príncipe, Rua Desembargador Motta, 1070 - Água Verde, 6° Andar, Curitiba, PR, 80250-060, Brazil.
| | - Caroline Mensor Folchini
- Department of Clinical Research, Hospital Pequeno Príncipe, Rua Desembargador Motta, 1070 - Água Verde, 6° Andar, Curitiba, PR, 80250-060, Brazil
| | | | | | | | - Marinei Campos Ricieri
- Department of Clinical Research, Hospital Pequeno Príncipe, Rua Desembargador Motta, 1070 - Água Verde, 6° Andar, Curitiba, PR, 80250-060, Brazil
- Value Management Office, Hospital Pequeno Príncipe, Curitiba, PR, Brazil
| | - Fábio Araújo Motta
- Department of Clinical Research, Hospital Pequeno Príncipe, Rua Desembargador Motta, 1070 - Água Verde, 6° Andar, Curitiba, PR, 80250-060, Brazil
- Value Management Office, Hospital Pequeno Príncipe, Curitiba, PR, Brazil
| | - Adriano Keijiro Maeda
- Department of Neurology, Hospital Pequeno Príncipe, Curitiba, PR, Brazil
- Department of Neurosurgery, Hospital Pequeno Príncipe, Curitiba, PR, Brazil
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Brasil S, Godoy DA, Videtta W, Rubiano AM, Solla D, Taccone FS, Robba C, Rasulo F, Aries M, Smielewski P, Meyfroidt G, Battaglini D, Hirzallah MI, Amorim R, Sampaio G, Moulin F, Deana C, Picetti E, Kolias A, Hutchinson P, Hawryluk GW, Czosnyka M, Panerai RB, Shutter LA, Park S, Rynkowski C, Paranhos J, Silva THS, Malbouisson LMS, Paiva WS. A Comprehensive Perspective on Intracranial Pressure Monitoring and Individualized Management in Neurocritical Care: Results of a Survey with Global Experts. Neurocrit Care 2024:10.1007/s12028-024-02008-z. [PMID: 38811514 DOI: 10.1007/s12028-024-02008-z] [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: 02/23/2024] [Accepted: 05/01/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Numerous trials have addressed intracranial pressure (ICP) management in neurocritical care. However, identifying its harmful thresholds and controlling ICP remain challenging in terms of improving outcomes. Evidence suggests that an individualized approach is necessary for establishing tolerance limits for ICP, incorporating factors such as ICP waveform (ICPW) or pulse morphology along with additional data provided by other invasive (e.g., brain oximetry) and noninvasive monitoring (NIM) methods (e.g., transcranial Doppler, optic nerve sheath diameter ultrasound, and pupillometry). This study aims to assess current ICP monitoring practices among experienced clinicians and explore whether guidelines should incorporate ancillary parameters from NIM and ICPW in future updates. METHODS We conducted a survey among experienced professionals involved in researching and managing patients with severe injury across low-middle-income countries (LMICs) and high-income countries (HICs). We sought their insights on ICP monitoring, particularly focusing on the impact of NIM and ICPW in various clinical scenarios. RESULTS From October to December 2023, 109 professionals from the Americas and Europe participated in the survey, evenly distributed between LMIC and HIC. When ICP ranged from 22 to 25 mm Hg, 62.3% of respondents were open to considering additional information, such as ICPW and other monitoring techniques, before adjusting therapy intensity levels. Moreover, 77% of respondents were inclined to reassess patients with ICP in the 18-22 mm Hg range, potentially escalating therapy intensity levels with the support of ICPW and NIM. Differences emerged between LMIC and HIC participants, with more LMIC respondents preferring arterial blood pressure transducer leveling at the heart and endorsing the use of NIM techniques and ICPW as ancillary information. CONCLUSIONS Experienced clinicians tend to personalize ICP management, emphasizing the importance of considering various monitoring techniques. ICPW and noninvasive techniques, particularly in LMIC settings, warrant further exploration and could potentially enhance individualized patient care. The study suggests updating guidelines to include these additional components for a more personalized approach to ICP management.
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Affiliation(s)
- Sérgio Brasil
- Division of Neurosurgery, Department of Neurology, School of Medicine University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil.
| | | | - Walter Videtta
- Intensive Care Unit, Hospital Posadas, Buenos Aires, Argentina
| | | | - Davi Solla
- Division of Neurosurgery, Department of Neurology, School of Medicine University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
| | - Fabio Silvio Taccone
- Department of Intensive Care, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Chiara Robba
- Anesthesia and Intensive Care, Scientific Institute for Research, Hospitalization and Healthcare, Policlínico San Martino, Genoa, Italy
| | - Frank Rasulo
- Neuroanesthesia, Neurocritical and Postoperative Care, Spedali Civili University Affiliated Hospital of Brescia, Brescia, Italy
| | - Marcel Aries
- Department of Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands
- School of Mental Health and Neurosciences, University Maastricht, Maastricht, The Netherlands
| | - Peter Smielewski
- Department of Clinical Neurosciences, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - Geert Meyfroidt
- Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Denise Battaglini
- Anesthesia and Intensive Care, Scientific Institute for Research, Hospitalization and Healthcare, Policlínico San Martino, Genoa, Italy
| | - Mohammad I Hirzallah
- Departments of Neurology, Neurosurgery, and Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Robson Amorim
- Division of Neurosurgery, Department of Neurology, School of Medicine University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
| | - Gisele Sampaio
- Neurology Department, São Paulo Federal University Medical School, São Paulo, Brazil
| | - Fabiano Moulin
- Neurology Department, São Paulo Federal University Medical School, São Paulo, Brazil
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | | | | | - Gregory W Hawryluk
- Cleveland Clinic Neurological Institute, Akron General Hospital, Fairlawn, OH, USA
- Uniformed Services University, Bethesda, USA
- Brain Trauma Foundation, New York, USA
| | - Marek Czosnyka
- Division of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
| | - Ronney B Panerai
- Cerebral Haemodynamics in Ageing and Stroke Medicine Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Lori A Shutter
- Departments of Critical Care Medicine, Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Soojin Park
- Departments of Neurology and Biomedical Informatics, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY, USA
| | - Carla Rynkowski
- Department of Urgency and Trauma, Medical Faculty, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Jorge Paranhos
- Intensive Care and Neuroemergency, Santa Casa de Misericórdia, São João del Rei, Brazil
| | - Thiago H S Silva
- Department of Intensive Care, School of Medicine University of São Paulo, São Paulo, Brazil
| | - Luiz M S Malbouisson
- Department of Intensive Care, School of Medicine University of São Paulo, São Paulo, Brazil
| | - Wellingson S Paiva
- Division of Neurosurgery, Department of Neurology, School of Medicine University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
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Brasil S, Godoy DA, Hawryluk GWJ. A Point-of-Care Noninvasive Technique for Surrogate ICP Waveforms Application in Neurocritical Care. Neurocrit Care 2024; 40:170-176. [PMID: 37438552 PMCID: PMC10861641 DOI: 10.1007/s12028-023-01786-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/12/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Sérgio Brasil
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Daniel A Godoy
- Neurointensive Care Unit, Sanatório Pasteur, Catamarca, Argentina
| | - Gregory W J Hawryluk
- Department of Neurosurgery, Cleveland Clinic and Akron General Hospital, Fairlawn, OH, USA
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Taylor Z, English C, Cramberg M, Young BA. The influence of spinal venous blood pressure on cerebrospinal fluid pressure. Sci Rep 2023; 13:20989. [PMID: 38017027 PMCID: PMC10684553 DOI: 10.1038/s41598-023-48334-8] [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: 08/01/2023] [Accepted: 11/25/2023] [Indexed: 11/30/2023] Open
Abstract
In Alligator mississippiensis the spinal dura is surrounded by a venous sinus; pressure waves can propagate in the spinal venous blood, and these spinal venous pressures can be transmitted to the spinal cerebrospinal fluid (CSF). This study was designed to explore pressure transfer between the spinal venous blood and the spinal CSF. At rest the cardiac-related CSF pulsations are attenuated and delayed, while the ventilatory-related pulsations are amplified as they move from the spinal venous blood to the spinal CSF. Orthostatic gradients resulted in significant alterations of both cardiac- and ventilatory-related CSF pulsations. Manual lateral oscillations of the alligator's tail created pressure waves in the spinal CSF that propagated, with slight attenuation but no delay, to the cranial CSF. Oscillatory pressure pulsations in the spinal CSF and venous blood had little influence on the underlying ventilatory pulsations, though the same oscillatory pulsations reduced the ventilatory- and increased the cardiac-related pulsations in the cranial CSF. In Alligator the spinal venous anatomy creates a more complex pressure relationship between the venous and CSF systems than has been described in humans.
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Affiliation(s)
- Z Taylor
- Department of Anatomy, Kirksville College of Osteopathic Medicine, Kirksville, MO, 63501, USA
| | - C English
- Department of Anatomy, Kirksville College of Osteopathic Medicine, Kirksville, MO, 63501, USA
| | - M Cramberg
- Department of Anatomy, Kirksville College of Osteopathic Medicine, Kirksville, MO, 63501, USA
| | - B A Young
- Department of Anatomy, Kirksville College of Osteopathic Medicine, Kirksville, MO, 63501, USA.
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Link C, D`Haese TM, Frigieri G, Brasil S, Vellosa JCR, Welling L. Intracranial compliance and volumetry in patients with traumatic brain injury. Surg Neurol Int 2023; 14:246. [PMID: 37560593 PMCID: PMC10408625 DOI: 10.25259/sni_314_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/27/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Cerebral edema (CE) and intracranial hypertension (IHT) are complications of numerous neurological pathologies. However, the study of CE and noninvasive methods to predict IHT remains rudimentary. This study aims to identify in traumatic brain injury (TBI) patients the relationship between the volume of the lateral ventricles and the parameters of the noninvasive intracranial pressure waveform (nICPW). METHODS This is an analytical, descriptive, and cross-sectional study with nonsurgical TBI patients. The monitoring of nICPW was performed with a mechanical strain gauge, and the volumetry of the lateral ventricles was calculated using the free 3D Slicer software, both during the acute phase of the injury. The linear model of fixed and random mixed effects with Gamma was used to calculate the influence of nICPW parameters (P2/P1 and time-to-peak [TTP]) values on volumetry. RESULTS Considering only the fixed effects of the sample, there was P = 0.727 (95% CI [-0.653; 0.364]) for the relationship between P2/P1 and volumetry and 0.727 (95% CI [-1.657; 1.305]) for TTP and volumetry. Considering the fixed and random effects, there was P = 8.5e-10 (95% CI [-0.759; 0.355]) for the relationship between P2/P1 and volumetry and 8.5e-10 (95% CI [-2.001; 0.274]) for TTP and volumetry. CONCLUSION The present study with TBI patients found association between nICPW parameters and the volume of the lateral ventricles in the 1st days after injury.
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Affiliation(s)
- Caroline Link
- Department of Neurology, Clinics Hospital Complex of the Federal University of Paraná, Curitiba, Brazil
| | - Thomas Markus D`Haese
- Department of Intensive care, State University of Ponta Grossa, Ponta Grossa, Brazil
| | - Gustavo Frigieri
- Braincare Desenvolvimento e Inovação Tecnológica SA - Brain4care, São Carlos, Brazil
| | - Sérgio Brasil
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Leonardo Welling
- Neurological Surgery, State University of Ponta Grossa, Ponta Grossa, Brazil
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Godoy DA, Brasil S, Iaccarino C, Paiva W, Rubiano AM. The intracranial compartmental syndrome: a proposed model for acute brain injury monitoring and management. Crit Care 2023; 27:137. [PMID: 37038236 PMCID: PMC10088257 DOI: 10.1186/s13054-023-04427-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/02/2023] [Indexed: 04/12/2023] Open
Abstract
For decades, one of the main targets in the management of severe acute brain injury (ABI) has been intracranial hypertension (IH) control. However, the determination of IH has suffered variations in its thresholds over time without clear evidence for it. Meanwhile, progress in the understanding of intracranial content (brain, blood and cerebrospinal fluid) dynamics and recent development in monitoring techniques suggest that targeting intracranial compliance (ICC) could be a more reliable approach rather than guiding actions by predetermined intracranial pressure values. It is known that ICC impairment forecasts IH, as intracranial volume may rapidly increase inside the skull, a closed bony box with derisory expansibility. Therefore, an intracranial compartmental syndrome (ICCS) can occur with deleterious brain effects, precipitating a reduction in brain perfusion, thereby inducing brain ischemia. The present perspective review aims to discuss the ICCS concept and suggest an integrative model for the combination of modern invasive and noninvasive techniques for IH and ICC assessment. The theory and logic suggest that the combination of multiple ancillary methods may enhance ICC impairment prediction, pointing proactive actions and improving patient outcomes.
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Affiliation(s)
| | - Sérgio Brasil
- Experimental Surgery Laboratory and Division of Neurological Surgery, University of São Paulo Medical School, Av. Eneas de Carvalho Aguiar 255, Sao Paulo, Brazil.
| | - Corrado Iaccarino
- Department of Biomedical, Metabolic and Neural Sciences, University Modena and Reggio Emilia, Modena, Italy
- Department of Neurosurgery, University Hospital of Modena, Modena, Italy
- Emergency Neurosurgery, AUSLRE IRCCS, Reggio Emilia, Italy
| | - Wellingson Paiva
- Experimental Surgery Laboratory and Division of Neurological Surgery, University of São Paulo Medical School, Av. Eneas de Carvalho Aguiar 255, Sao Paulo, Brazil
| | - Andres M Rubiano
- Universidad El Bosque. Bogotá, Bogotá, Colombia
- MEDITECH Foundation, Cali, Colombia
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Shapshak AH, Shutter L. Neurocritical Care Education in the United States. Crit Care Clin 2023; 39:29-46. [DOI: 10.1016/j.ccc.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brasil S, Frigieri G, Taccone FS, Robba C, Solla DJF, de Carvalho Nogueira R, Yoshikawa MH, Teixeira MJ, Malbouisson LMS, Paiva WS. Noninvasive intracranial pressure waveforms for estimation of intracranial hypertension and outcome prediction in acute brain-injured patients. J Clin Monit Comput 2022; 37:753-760. [PMID: 36399214 PMCID: PMC9673225 DOI: 10.1007/s10877-022-00941-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022]
Abstract
Analysis of intracranial pressure waveforms (ICPW) provides information on intracranial compliance. We aimed to assess the correlation between noninvasive ICPW (NICPW) and invasively measured intracranial pressure (ICP) and to assess the NICPW prognostic value in this population. In this cohort, acute brain-injured (ABI) patients were included within 5 days from admission in six Intensive Care Units. Mean ICP (mICP) values and the P2/P1 ratio derived from NICPW were analyzed and correlated with outcome, which was defined as: (a) early death (ED); survivors on spontaneous breathing (SB) or survivors on mechanical ventilation (MV) at 7 days from inclusion. Intracranial hypertension (IHT) was defined by ICP > 20 mmHg. A total of 72 patients were included (mean age 39, 68% TBI). mICP and P2/P1 values were significantly correlated (r = 0.49, p < 0.001). P2/P1 ratio was significantly higher in patients with IHT and had an area under the receiving operator curve (AUROC) to predict IHT of 0.88 (95% CI 0.78–0.98). mICP and P2/P1 ratio was also significantly higher for ED group (n = 10) than the other groups. The AUROC of P2/P1 to predict ED was 0.71 [95% CI 0.53–0.87], and the threshold P2/P1 > 1.2 showed a sensitivity of 60% [95% CI 31–83%] and a specificity of 69% [95% CI 57–79%]. Similar results were observed when decompressive craniectomy patients were excluded. In this study, P2/P1 derived from noninvasive ICPW assessment was well correlated with IHT. This information seems to be as associated with ABI patients outcomes as ICP. Trial registration: NCT03144219, Registered 01 May 2017 Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/NCT03144219.
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Affiliation(s)
- Sérgio Brasil
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, 255 Enéas Aguiar Street, São Paulo, 05403000 Brazil
| | - Gustavo Frigieri
- Medical Investigation Laboratory 62, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hôpital, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Chiara Robba
- Department of Intensive Care, Universitá degli Studi di Genoa, Genoa, Italy
| | - Davi Jorge Fontoura Solla
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, 255 Enéas Aguiar Street, São Paulo, 05403000 Brazil
| | - Ricardo de Carvalho Nogueira
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, 255 Enéas Aguiar Street, São Paulo, 05403000 Brazil
| | - Marcia Harumy Yoshikawa
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, 255 Enéas Aguiar Street, São Paulo, 05403000 Brazil
| | - Manoel Jacobsen Teixeira
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, 255 Enéas Aguiar Street, São Paulo, 05403000 Brazil
| | | | - Wellingson Silva Paiva
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, 255 Enéas Aguiar Street, São Paulo, 05403000 Brazil
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Small C, Scott K, Smart D, Sun M, Christie C, Lucke-Wold B. Microglia and Post-Subarachnoid Hemorrhage Vasospasm: Review of Emerging Mechanisms and Treatment Modalities. CLINICAL SURGERY JOURNAL 2022; 3:INF1000213. [PMID: 36081602 PMCID: PMC9450560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Vasospasm is a potentially severe complication of subarachnoid hemorrhage. It can be attributed to neuroinflammation and the robust recruitment of microglia. Emerging evidence has linked this sustained inflammation to the development of delayed cerebral ischemia following subarachnoid hemorrhage. In this focused review, we provide an overview of the historical understanding of vasospasm. We then delve into the role of neuroinflammation and the activation of microglia. These activated microglia releases a host of inflammatory cytokines contributing to an influx of peripheral macrophages. This thereby opens a new and innovative treatment strategy to prevent vasospasm. Pre-clinical work has been promising, and the transition to clinical trials is warranted. Finally, some of the key mechanistic targets are outlined with emphasis on translation. This review will serve as a catalyst for researchers and clinicians alike in the quest to improve treatment options for vasospasm.
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Affiliation(s)
- Coulter Small
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA
| | - Kyle Scott
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA
| | - Derek Smart
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA
| | - Michael Sun
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA
| | - Carlton Christie
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA
| | - Brandon Lucke-Wold
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA
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What Are We Measuring? A Refined Look at the Process of Disrupted Autoregulation and the Limitations of Cerebral Perfusion Pressure in Preventing Secondary Injury after Traumatic Brain Injury. Clin Neurol Neurosurg 2022; 221:107389. [PMID: 35961231 DOI: 10.1016/j.clineuro.2022.107389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022]
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Barpujari A, Pierre K, Dodd W, Dagra A, Small C, Williams E, Clark A, Lucke-Wold B. Lessons from NATURE: methods for traumatic brain injury prevention. ARCHIVES OF CLINICAL TOXICOLOGY 2021; 3:34-41. [PMID: 34993525 PMCID: PMC8730289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Multiple species obtain repetitive head collisions throughout the course of their lifetimes with minimal neurologic deficit. Nature has allowed the unique development of multiple protective mechanisms to help prevent neurotrauma. In this review, we examine the concept of rapid brain movement within the skull 'Slosh' and what nature teaches on how to prevent this from occurring. We look at individual animals and the protective mechanisms at play. Marching from macroscopic down to the molecular level, we pinpoint key elements of neuroprotection that are likely contributing. We also introduce new concepts for neuroprotection and address avenues of further discovery.
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Affiliation(s)
- Arnav Barpujari
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Kevin Pierre
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - William Dodd
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Abeer Dagra
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Coulter Small
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Eric Williams
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Alec Clark
- Department of Neurosurgery, University of Florida, Gainesville, USA
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