Dysautonomia secondary to third ventriculostomy successfully managed with midodrine

2020 ◽  
Vol 13 (6) ◽  
pp. e232767
Author(s):  
Torcato Moreira Marques ◽  
André Almeida ◽  
Joana Pinheiro ◽  
Paula Oliveira Nascimento
Keyword(s):  
Blood Pressure ◽  
Favourable Result ◽  
Third Ventriculostomy ◽  
Neurosurgical Procedures ◽  
Hypothalamic Dysfunction ◽  
On Demand ◽  
Hypothalamic Lesions ◽  
Adequate Control ◽  
Medical Approach

Hypothalamic lesions can compromise its essential regulatory roles resulting in critical disruption of temperature and blood pressure homoeostasis. We present the case of a 55-year-old woman who had been previously submitted to several neurosurgical procedures aimed at treating idiopathic hydrocephalus. She presented to our department with recurring episodes of hypothermia and wide blood pressure variations, which had been worsening over the last few years. After extensive complementary workup, which excluded new neurological lesions or endocrinological conditions, hypothalamic dysfunction was assumed to be the cause of this syndrome. She was successfully treated with midodrine and on-demand captopril, which resulted in adequate control of her blood pressure. This case highlights the rare and unpredictable consequences of damage to the hypothalamus, depicting the favourable result of a heretofore unpublished medical approach.

Hypothalamic Lesions Induce Obesity and Sex-Dependent Glomerular Damage and Increases in Blood Pressure in Rats

Hypertension ◽  
1996 ◽  
Vol 27 (4) ◽  
pp. 926-932 ◽  
Author(s):  
Chris Baylis ◽  
Lennie Samsell ◽  
Lorraine Racusen ◽  
Wil Gladfelter
Keyword(s):  
Blood Pressure ◽  
Hypothalamic Lesions ◽  
Glomerular Damage

Cerebral hemorrhage and edema following brain biopsy in rats: significance of mean arterial blood pressure

2000 ◽  
Vol 92 (1) ◽  
pp. 100-107 ◽  
Author(s):  
Helene Benveniste ◽  
Katie R. Kim ◽  
Laurence W. Hedlund ◽  
John W. Kim ◽  
Allan H. Friedman
Keyword(s):  
Blood Pressure ◽  
Arterial Blood Pressure ◽  
Mean Arterial Blood Pressure ◽  
Neurosurgical Procedures ◽  
Shr Rats ◽  
Mr Microscopy ◽  
Content Type ◽  
Wky Rats ◽  
Arterial Blood ◽  
Fine Print

Object. It is taken for granted that patients with hypertension are at greater risk for intracerebral hemorrhage during neurosurgical procedures than patients with normal blood pressure. The anesthesiologist, therefore, maintains mean arterial blood pressure (MABP) near the lower end of the autoregulation curve, which in patients with preexisting hypertension can be as high as 110 to 130 mm Hg. Whether patients with long-standing hypertension experience more hemorrhage than normotensive patients after brain surgery if their blood pressure is maintained at the presurgical hypertensive level is currently unknown. The authors tested this hypothesis experimentally in a rodent model.Methods. Hemorrhage and edema in the brain after needle biopsy was measured in vivo by using three-dimensional magnetic resonance (MR) microscopy in the following groups: WKY rats, acutely hypertensive WKY rats, spontaneously hypertensive rats (SHR strain), and SHR rats treated with either sodium nitroprusside or nicardipine. Group differences were compared using Tukey's studentized range test followed by individual pairwise comparisons of groups and adjusted for multiple comparisons.There were no differences in PaCO2, pH, and body temperature among the groups. The findings in this study indicated that only acutely hypertensive WKY rats had larger volumes of hemorrhage. Chronically hypertensive SHR rats with MABPs of 130 mm Hg did not have larger hemorrhages than normotensive rats. There were no differences in edema volumes among groups.Conclusions. The brains of SHR rats with elevated systemic MABPs are probably protected against excessive hemorrhage during surgery because of greater resistance in the larger cerebral arteries and, thus, reduced cerebral intravascular pressures.

Attenuation of Haemodynamic Response to Placement of Mayfield Skull Pin Head Holder - Comparison of Dexmedetomidine Versus Propofol Infusion - A Randomized Interventional Trial Done in a Tertiary Centre in Central Kerala

2021 ◽  
Vol 8 (29) ◽  
pp. 2639-2643
Author(s):  
Sruthy Unni ◽  
Ranju Sebastian ◽  
Elizabeth Joseph ◽  
Remani Kelan Kamalakshi ◽  
Jamsheena Muthira Parambath
Keyword(s):  
Blood Pressure ◽  
Nervous System ◽  
Stress Response ◽  
Intracranial Pressure ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Neurosurgical Procedures ◽  
Sympathetic Nervous ◽  
The Brain ◽  
Group 1

BACKGROUND Anaesthesia for neurosurgery requires special considerations. The brain is enclosed in a rigid cranium, so the rise in intracranial pressure (ICP) which impairs cerebral perfusion pressure (CPP), results in irrepairable damage to various vital areas in the brain. Stable head position is required in long neurosurgical procedures. This is obtained with the use of clamps which fix the head rigidly. This is done usually under general anaesthesia because it produces intense painful stimuli leading to stimulation of sympathetic nervous system which in turn causes release of vasoconstrictive agents. This can impair perfusion in all organ systems. The increase in blood pressure due to sympathetic nervous system causes increase in blood flow. This causes increases in intracranial pressure which result in reduction in cerebral perfusion pressure once the auto regulatory limits are exceeded. We compared the effects of dexmedetomidine 1 µgm/kg and propofol 100 µgm/kg given as infusion over a period of 10 minutes before the induction of anaesthesia and continued till 5 minutes after pinning to attenuate the stress response while cranial pinning. In this study, we wanted to compare the effects of dexmedetomidine and propofol as infusion to attenuate the stress response while cranial pinning in patients undergoing neurosurgical procedures. METHODS This is a randomized interventional trial. Patients were divided into 2 groups of 20 each. Group 1 receiving dexmedetomidine and group 2 receiving propofol, both drugs given as infusion. Haemodynamic variables were monitored before and after cranial pinning. Data was analysed using IBM statistical package for social sciences (SPSS) statistics. The parameters recorded were analysed with the help of a statistician. RESULTS The two groups were comparable in demographic data. Incidence of tachycardia between group 1 and 2 showed that tachycardia to pinning was better controlled with propofol than dexmedetomidine (P < 0.05) which is statistically significant. There is no statistically significant difference in blood pressure values between group 1 and 2 after pinning. CONCLUSIONS From our study, we came to a conclusion that propofol was superior to dexmedetomidine in attenuating the heart rate response to cranial pinning. The effect of propofol and dexmedetomidine was comparable in attenuating the blood pressure response to cranial pinning. KEYWORDS Cranial Pinning, Dexmedetomidine, Propofol

Prospective surveillance of complications in a pediatric neurosurgery unit

2010 ◽  
Vol 5 (6) ◽  
pp. 544-548 ◽  
Author(s):  
James M. Drake ◽  
Jay Riva-Cambrin ◽  
Andrew Jea ◽  
Kurtis Auguste ◽  
Mandeep Tamber ◽  
...  
Keyword(s):  
External Ventricular Drain ◽  
Pediatric Neurosurgery ◽  
Shunt Infection ◽  
Shunt Revision ◽  
Third Ventriculostomy ◽  
Neurosurgical Procedures ◽  
Csf Leakage ◽  
Second Procedure ◽  
Shunt Infections ◽  
Csf Leaks

Object Complications of specific pediatric neurosurgical procedures are well recognized. However, focused surveillance on a specific neurosurgical unit, for all procedures, may lead to better understanding of the most important complications, and allow targeted strategies for quality improvement. Methods The authors prospectively recorded the morbidity and mortality events at a large pediatric neurosurgical unit over a 2-year period. Morbidity was defined as any significant adverse outcome or death (for obstructive shunt failure, within 30 days). Multiple and unrelated complications in the same patient were recorded as separate events. Results There were 1082 surgical procedures performed during the evaluation period. One hundred seventy-seven complications (16.4%) occurred in 147 patients. By procedure, the most common complications occurred in vascular surgery (41.7%) and brain tumor surgery (27.9%). The most common complications were CSF leakage (31 cases), a new neurological deficit (27 cases), early shunt or endoscopic third ventriculostomy obstruction (27 cases), and shunt infection (24 cases). Meningitis occurred in 19 cases: in 58% of shunt infections, 13% of CSF leaks, and 10% of wound infections. Sixty-four percent of adverse events required a second procedure, most commonly an external ventricular drain placement or shunt revision. Conclusions Complications in pediatric neurosurgical procedures are common, result in significant morbidity, and more than half the time require a repeat surgical procedure. Targeted strategies to prevent common complications, such as shunt infections or CSF leaks, might significantly reduce this burden.

Haemodynamic Changes Associatedc with Obesity and High Blood Pressure in Crats with Ventromedial Hypothalamic Lesions

1980 ◽  
Vol 59 (s6) ◽  
pp. 397s-399s ◽  
Author(s):  
E. Reisin ◽  
D. H. Suarez ◽  
E. D. Frohlich
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
High Blood Pressure ◽  
Plasma Volume ◽  
Mild Hypertension ◽  
Male Rats ◽  
Volume Changes ◽  
Hypothalamic Lesions ◽  
Haemodynamic Changes ◽  
Mild Obesity

1. The haemodynamic and plasma volume changes associated with obesity and high blood pressure were studied in nine male rats with electrolytic ventromedial hypothalamic lesions and their paired sham-operated controls. Body weight and arterial pressure were greater in the rats with ventromedial hypothalamic lesions (565 ± 16 vs 462 ± 14 g, P&lt;0.001; 128 ± 3 vs 118 ± 3 mmHg, P&lt;0.05, respectively). Cardiac output was slightly elevated, and that portion of cardiac output distributed to the kidneys was reduced (P&lt;0.001). Plasma volume was contracted in the rats with ventromedial hypothalamic lesions (21.0 ± 0.1 vs 2.8 ± 0.1 ml/100 g, P&lt;0.001). 2. The haemodynamic characteristics of rats in which obesity and mild hypertension have been induced by electrolytic ventromedial hypothalamic lesion are similar to mild obesity essential hypertension in men.

Microsurgical and Endoscopic Anatomy of Liliequist's Membrane: A Complex and Variable Structure of the Basal Cisterns

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS1-ONS9 ◽  
Author(s):  
Sebastien C. Froelich ◽  
Khaled M. Abdel Aziz ◽  
Paul D. Cohen ◽  
Harry R. van Loveren ◽  
Jeffrey T. Keller
Keyword(s):  
Variable Structure ◽  
Arachnoid Cysts ◽  
Surgical Approaches ◽  
Third Ventriculostomy ◽  
Neurosurgical Procedures ◽  
Endoscopic Anatomy ◽  
Perimesencephalic Hemorrhage ◽  
Neurovascular Structures ◽  
Liliequist’S Membrane ◽  
Formalin Fixed

Abstract Objective: Descriptions of Liliequist's membrane, as reported in the literature, vary considerably. In our cadaveric study of Liliequist's membrane, we attempted to clarify and define its anatomic features and boundaries, as well as its relationship with surrounding neurovascular structures. We describe the embryology of this membrane as a remnant of the primary tentorium. The clinical significance of our findings is discussed with respect to third ventriculostomy and surgical approaches to basilar tip aneurysms, suprasellar arachnoid cysts, and perimesencephalic hemorrhage. Methods: Thirteen formalin-fixed adult cadaveric heads were injected with colored silicone. After endoscopic exploration of Liliequist's membrane, a bilateral frontal craniotomy was performed, and the frontal lobes were removed to fully expose Liliequist's membrane. Results: Liliequist's membrane is a complex and highly variable structure that is composed of either a single membrane or two leaves. The membrane was absent in two specimens without any clear demarcation between the interpeduncular, prepontine, and chiasmatic cisterns. Conclusion: Understanding the variable anatomy of Liliequist's membrane is important, particularly to improve current and forthcoming microsurgical and endoscopic neurosurgical procedures. It is important as a surgical landmark in various neurosurgical operations and in the physiopathology of several pathological processes (suprasellar arachnoid cysts and perimesencephalic hemorrhage).

Blood Pressure on Demand

Science News ◽  
1967 ◽  
Vol 91 (15) ◽  
pp. 365
Keyword(s):  
Blood Pressure ◽  
On Demand

scholarly journals Prospective Study of Central Venous Pressure Trends during Major Neurosurgical Procedures in an Elective Operation Theatre Setting of a Tertiary Care Centre

2021 ◽  
Vol 8 (07) ◽  
pp. 369-373
Author(s):  
Rajeev Damodaran Sarojini ◽  
Sanjay Sahadevan ◽  
Jayakumar Christhudas
Keyword(s):  
Blood Pressure ◽  
Intracranial Pressure ◽  
Prospective Study ◽  
Central Venous Pressure ◽  
Inferior Vena ◽  
Venous Pressure ◽  
Ultra Sound ◽  
Neurosurgical Procedures ◽  
Central Venous ◽  
Intraoperative Period

BACKGROUND There are extensive variations in central venous pressure during intraoperative period of a major neurosurgical patients. Monitoring of central venous pressure is vital for guiding the administration of fluids, blood and blood products. Central venous pressure (CVP) also measures the intracranial pressure indirectly. Increased intracranial pressure thereby reduces the cerebral blood flow, leading to cerebral ischemia. METHODS This is a prospective study where 25 major neurosurgical cases posted for elective major neurosurgery were selected. Right subclavian vein was selected for cannulation, by blind technique in all these cases. CVP was recorded every 15 minutes. Central venous catheter was connected to a pressure transducer linked to a multichannel monitor; zeroing was done and the CVP reading obtained. RESULTS Central venous pressure reading was done serially and showed the trends in haemodynamics in various stages of surgery. Initial intraoperative periods showed lower values due to intravenous (I / V) induction of anaesthesia, use of mannitol and diuretics. Later on, the trends changed to higher side subsequent to administration of fluids and blood as required. CONCLUSIONS Monitoring of CVP is an important component of haemodynamic monitoring along with non-invasive blood pressure (NIBP), intra-arterial blood pressure (IABP), and urine output. Central venous pressure can be used to aspirate an air embolism occurring during the intraoperative period after employing Durant’s position. KEYWORDS CVP, NIBP , USS – Ultra Sound Scan, IVC – Inferior Vena Cava, IVCCI – Inferior Vena Cave Collapsibility Index, PEEP – Positive End Expiratory Pressure, C / L – Central Line, IABP.

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