Time course of cerebral vasospasm after severe head injury.
Explore the source record for details and available documents.
Blood Flow Velocity↗
Biomedical subjects
R W Seiler
Publications and source records attributed to R W Seiler.
Age dependence of the flow velocity in the basal cerebral arteries--a transcranial Doppler ultrasound study.
The age dependence of the blood flow velocities of the middle, anterior, and posterior cerebral arteries measured by the transcranial Doppler method is discussed and compared with the velocity values in the internal carotid artery. A number of 535 patients without neurological deficits but with a previous neurological event were examined. Flow velocities decrease in all examined vessels with increasing age. This is in accordance with cerebral blood flow measurements by Xenon inhalation techniques. The reasons of the decrease and its consequences on the vasospasm in patients suffering from subarachnoidal hemorrhage are discussed.
Adolescent↗
Outcome of aneurysmal subarachnoid hemorrhage in a hospital population: a prospective study including early operation, intravenous nimodipine, and transcranial Doppler ultrasound.
A total of 153 consecutive patients with proven aneurysmal subarachnoid hemorrhages (SAHs) admitted immediately after diagnosis regardless of clinical condition were managed according to the same protocol. The initial evaluation included computed tomography (CT), transcranial Doppler ultrasound (TCD), angiography-CT, and/or angiography. Intravenous nimodipine (2 mg/hour) was started after confirmation of the diagnosis. The timing of operation was determined individually according to age, clinical course, and CT and TCD findings. Twenty-one Grade V patients treated with intensive care and ventriculostomy died or did not improve within 24 hours after SAH. Three patients with life-threatening intracerebral hematomas underwent emergency operation. Operation was early in 55 good risk patients and late in 57 patients because of poor initial grade, late admission, or logistic reasons. Seventeen patients had no operation because of old age, persistent poor clinical condition, medical complication, or lethal rebleeding before operation. In the total series, 90 patients (59%) made a full recovery, the overall morbidity rate was 14% (21 of 153 cases), and the mortality rate was 27% (42 of 153). Postoperative mortality including emergency evacuation of hematomas was 7.8% and mortality after elective operation was 6.2%. The causes of disability and death were the initial effect of the hemorrhage in 25 patients (16.3%), rebleeding in 15 (9.8%), delayed cerebral infarction in 8 (5.2%), surgical complications in 7 (4.5%), hydrocephalus in 4 (2.6%), and medical complications in 4 (2.6%).
Adolescent↗
Orthodromic (intra/extracranial) neurography to monitor facial nerve function intraoperatively.
This report introduces the technique of orthodromic neurography for monitoring of facial nerve function during operation in the cerebellopontine angle. By stimulation of the intracisternal segment of the facial nerve, a compound nerve action potential with amplitudes of 15 to 480 microV can be recorded extracranially from the nerve near the stylomastoid foramen after 0.95 to 2.27 ms. Usually there is no need for signal averaging, and the method is independent of the effect of muscle relaxants. With the use of the same electrophysiological equipment as for evoked potential neuromonitoring, immediate and repeated localization of the facial nerve and its discrimination from the trigeminal and the lower cranial nerves during nerve preparation within the tumor capsule is possible.
Action Potentials↗
[Subarachnoid hemorrhage in pregnancy].
Subarachnoid hemorrhage during pregnancy is a rare neurological event which, due to the time of onset and clinical findings, may be mistaken for eclampsia, a purely obstetric complication. Timely specific diagnosis will lead to consultation of the neurosurgeon who, on the basis of non-invasive techniques, determines the optimal timing for surgery to ensure a favourable prognosis for mother and child. The clinical aspects, and the diagnostic and therapeutic procedures are illustrated by three clinical cases at various stages of pregnancy and on the basis of a short review of the literature.
Adult↗
Evaluation of the calcium-antagonist nimodipine for the prevention of vasospasm after aneurysmal subarachnoid haemorrhage. A prospective transcranial Doppler ultrasound study.
70 consecutive patients admitted within four days after the first aneurysmal subarachnoid haemorrhage (SAH) were evaluated by daily transcranial Doppler ultrasound (TCD) measurement of the blood flow velocities (BFVs) of both middle cerebral arteries (MCAs) and by daily recordings of their clinical grade (Hunt and Hess). Patients with no or only little subarachnoid blood in the first CT after admission were classified as low-risk for the development of symptomatic vasospasm (VSP), and patients with big subarachnoid clots or thick layers of subarachnoid blood were graded as high-risk patients for symptomatic VSP. The first series of 33 patients received no nimodipine whereas the second series of 37 patients were treated with nimodipine 2 mg/h intravenously, starting within 24 hours after the SAH in the majority of patients. 7-14 days postoperatively, the intravenous dose was changed to oral nimodipine 60 mg/q4h for one week and then discontinued. A mean BFV curve of the side with the higher flow velocities correlated with the mean clinical status (Hunt and Hess) was calculated by computer analysis for the patients treated without nimodipine and for those receiving nimodipine in each risk group. The mean BFV curves of the same risk groups were compared in order to evaluate the effect of nimodipine for the prevention of vasospasm following SAH. The delayed neurological deficits (DIND) and the functional outcome six months after the SAH were recorded in each group and compared. Nimodipine given within four days after the SAH did not prevent vasospasm evaluated by TCD, but it significantly reduced the severity of the vasoconstriction, especially in high-risk patients. It reduced significantly the incidence of DIND in high-risk patients and improved their functional outcome. Although nimodipine may have a reduced efficacy in preventing vasospasm after early operation of high-risk patients, it probably protects the brain by increasing its tolerance to focal ischaemia.
Adult↗
Morbidity and mortality of carotid endarterectomy. A literature review of the results reported in the last 10 years.
A review of the mortality and morbidity of carotid endarterectomy reported during the last 10 years was made and compared to the risk of carotid stenosis managed by the best medical treatment. For comparison, the patients were classified in asymptomatic patients (grade I), patients with transient ischaemic attacks (grade II), patients with ischaemic neurological deficits operated on acutely (grade III) and into patients with no or incomplete recovery 4-6 weeks after the stroke (grade IV). Based on the results of this literature review, only patients in grade II seem to benefit from carotid endarterectomy.
Carotid Artery Diseases↗
[Possibilities and limits of transcranial Doppler sonography].
A review of our 4-years' experience with the transcranial Doppler technique in the evaluation of cerebrovascular disease is given. The physiological variations of the measured parameters and their clinical significance are presented. The diagnosis of occlusive diseases, spasms after subarachnoid haemorrhage, arteriovenous malformations and brain death are discussed. Some technical problems and limiting factors in diagnosis are summarised.
Blood Flow Velocity↗
Supratentorial intracerebral hemorrhage after posterior fossa operation.
Three cases of supratentorial intracerebral hemorrhage after posterior fossa operation are described, and nine other cases reported in the literature are reviewed. The possible causes are discussed, but in eight cases no definite cause could be found. All eight patients were operated on in the sitting position, and all had hematomas in the subcortical white matter. A possible cause might be changes in intracranial dynamics in the sitting position with disruption of subcortical veins. Other authors mention the possibility of occlusion of carotid or vertebral vessels in the neck by improper positioning of the head leading to intraoperative infarction and to hemorrhage within the infarcted brain after repositioning of the patient. With the patient in a lateral or semilateral position, this complication should be preventable.
Aged↗
Cerebral vasospasm evaluated by transcranial ultrasound correlated with clinical grade and CT-visualized subarachnoid hemorrhage.
In 39 patients with a proven subarachnoid hemorrhage (SAH), the clinical status, the amount of subarachnoid blood on a computerized tomography scan obtained within 5 days after SAH, and the flow velocities (FV's) in both middle cerebral arteries (MCA's) measured by transcranial Doppler sonography were recorded daily and correlated. All patients had pathological FV's over 80 cm/sec between Day 4 and Day 10 after SAH. The side of the ruptured aneurysm showed higher FV's than did the unaffected side in cases of laterally localized aneurysms. Increase in FV preceded clinical manifestation of ischemia. A step early increase of FV's portended severe ischemia and impending infarction. Maximum FV's in the range of 120 to 140 cm/sec were not critical and in no case led to brain infarction. Maximum FV's over 200 cm/sec were associated with a tendency for ischemia, but the patients may remain clinically asymptomatic. In cases of no or only a little blood in the basal cisterns, mean FV's in both MCA's increased only moderately whereas, with thick clots of subarachnoid blood, there was a steeper and higher increase of mean FV's.
Adult↗
Management of obstructive hydrocephalus secondary to posterior fossa tumors by steroids and subcutaneous ventricular catheter reservoir.
In 61 patients (38 adults and 23 children) with surgically treatable tumors of the posterior fossa and obstructive hydrocephalus the following treatment for hydrocephalus was employed: a high dose of steroids was given after diagnosis; a frontal ventricular catheter with a subcutaneous fluid reservoir (Rickham) was inserted within 2 to 5 days; a temporary external ventricular drainage system was attached to the reservoir if, despite the steroids, intracranial pressure was over 30 cm H2O; and tumor excision was performed within 5 days to reopen the cerebrospinal fluid (CSF) pathways. In view of the wide range of potential complications, it was decided not to use a shunt before craniotomy. A shunt was inserted only if the CSF pathways remained obstructed after tumor removal. With this regimen, 93% of all patients (100% of the adults and 83% of the children) were shunt-free after the operation, without fatal complications. The infection rate was 4.9%. It was concluded that the severity of symptoms of raised intracranial pressure from hydrocephalus, the intraventricular pressure, and the size or location of the tumor prior to surgery do not have prognostic value as to which patients will require a shunt after surgery.
Adult↗
[Multimodal treatment of undifferentiated astrocytomas of the cerebrum. Indications for chemotherapy].
Explore the source record for details and available documents.
Antineoplastic Combined Chemotherapy Protocols↗
Antiestrogenic therapy of meningiomas--a pilot study.
Six patients with inoperable, nonoperative, or recurrent meningiomas were treated with the antiestrogenic agent tamoxifen (Nolvadex) during an 8-12-month period. Computer tomographic, scintigraphic, and clinical evidence of an unspecific tumor response was only encountered in one patient after 4 months of therapy with tamoxifen. The 2-year results did not indicate a favorable response to antiestrogenic treatment. The significance of sex-steroid receptors and their possible prognostic value in endocrine therapy of meningiomas is discussed.
Aged↗
Chronic subdural hematomas: to drain or not to drain?
A consecutive series of 21 adult patients with chronic subdural hematoma was studied in respect to postoperative resolution of subdural collections and clinical improvement after burr hole evacuation without subdural drainage. This series was compared to a previously studied series of patients with chronic subdural hematoma in whom postoperative closed system drainage had been installed. Using the identical protocol for treatment and postoperative follow-up, we obtained identical results with respect to time-related neurological improvement and persistence of subdural collections in the undrained and drained series, except that the steadily progressive clinical improvement during the early postoperative phase (24 hours) in all cases of the drained series was not universal in the undrained cases. Our study suggests that, to avoid the possibility of early postoperative clinical deterioration, burr hole craniostomy and closed system drainage is advisable. We think that subdural drainage is not necessary when the installation of the drainage system seems to be technically difficult, as it may be in cases with considerable perioperative cortical expansion.
Adult↗
Dependency of blood flow velocity in the middle cerebral artery on end-tidal carbon dioxide partial pressure--a transcranial ultrasound Doppler study.
The end-tidal carbon dioxide partial pressure (PCO2) response curves for the flow velocity in the middle cerebral artery were studied in 31 normal subjects with transcranial Doppler techniques. An exponential curve with an exponent of 0.034 mm Hg-1 was found to be a good fit to the recorded data. By means of this relationship, recordings of flow velocity in cerebral arteries can be normalized to a standard value of PCO2. Physiological aspects of cerebrovascular reactivity to PCO2 and the clinical implications of the PCO2 response curve are discussed. The normal material provides a reference for assessing pathological responses.
Adolescent↗
[Therapy and prognosis of subarachnoid hemorrhage due to rupture of a cerebral aneurysm].
The morbidity and mortality in 100 consecutive patients, almost all admitted within one week after a proven subarachnoid hemorrhage, were investigated in a prospective study. An aneurysm was demonstrated by angiography or autopsy in 76 patients, while in 24 patients the cerebral panangiography was normal. 13.1% of the patients with a proven aneurysm died within 48 hours of the hemorrhage as a consequence of a massive initial bleeding, 23.6% died from preoperative rebleeding or brain infarcts due to cerebral vascular spasms, 2.6% from direct operative complications and 2.6% from brain infarcts due to postoperative cerebral vascular spasms. The total case mortality was 41.9%. This high mortality was due to massive initial hemorrhage, early rebleedings and in particular to pre- and postoperative brain infarcts due to cerebral vascular spasms. The prognosis can only be improved significantly by early diagnosis and admission and effective prophylaxis and therapy of the vasospasm, but not by further perfecting of surgical technique.
Humans↗
[Undifferentiated astrocytoma of the cerebrum. A review of current therapeutic possibilities].
Explore the source record for details and available documents.
Adrenal Cortex Hormones↗
Late results of multimodality therapy of high-grade supratentorial astrocytomas.
Fifty-one patients with histologically proved astrocytomas grades III and IV treated with postoperative irradiation and chemotherapy were evaluated with serial computerized tomographic (CT) scans and with special regard to their functional state 30 months after operation. Fourteen patients (27.4%) are still alive, but only 7 of them have a good performance status. The impaired functional state of 6 (11.7%) of the other 7 patients was caused by a secondary progressive dementia with radiological signs of diffuse cerebral atrophy and leukoencephalopathy, but no signs of recurrent tumors. The best explanation for this is a synergistic toxic action of whole brain irradiation and chemotherapy. Measuring survival time for evaluation of brain tumor therapy is of limited value without examination of the performance status and sequential CT scans.
Adult↗