scholarly journals Paradoxical Herniation following Decompressive Craniectomy in the Subacute Setting

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Alex P. Michael ◽  
Jose Espinosa
Keyword(s):  
Medical Treatment ◽  
Intracranial Hypertension ◽  
Treatment Option ◽  
Decompressive Craniectomy ◽  
Supine Position ◽  
Unique Case ◽  
Adequate Hydration ◽  
Standard Medical Treatment ◽  
Uncommon Complication

Decompressive craniectomy is reserved for extreme cases of intracranial hypertension. An uncommon complication known as paradoxical herniation has been documented within weeks to months following surgery. Here we present a unique case within days of surgery. Since standard medical treatment for intracranial hypertension will exacerbate paradoxical herniation, any abrupt neurological changes following decompressive craniectomy should be carefully investigated. Immediate treatment for paradoxical herniation is placement of the patient in the supine position with adequate hydration. Cranioplasty is the ultimate treatment option.

scholarly journals Decompressive craniectomy combined with mild hypothermia in patients with large hemispheric infarction: A randomized controlled trial

2020 ◽  
Author(s):  
Linlin Fan ◽  
Yingying Su ◽  
Yan Zhang ◽  
Hong Ye ◽  
Weibi Chen ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Decompressive Craniectomy ◽  
Neurological Outcome ◽  
Mortality Rates ◽  
Target Temperature ◽  
Good Neurological Outcome ◽  
Neurological Outcomes ◽  
Significant Difference ◽  
Standard Medical Treatment ◽  
Hemispheric Infarction

Abstract Background: To investigate the effects of decompressive craniectomy (DC) combined with hypothermia treatment on mortality and neurological outcomes in patients with large hemispheric infarction (LHI).Methods: Patients within 48 hours of symptom onset were randomized to the following three groups: the DC group, the DC plus head surface cooling (DCSC) group and the DC plus endovascular hypothermia (DCEH) group. Patients in the DC group were given standard medical treatment with a normothermic target temperature. Patients in the DCSC group received standard medical treatment plus 24-hour ice cap on the head for 7 days. Patients in the DCEH group were given standard medical treatment plus endovascular hypothermia with a target temperature of 34°C. The primary end-points were mortality and modified Rankin Scale (mRS) score at 6 months.Results: There were 9 patients in the DC group, 14 patients in the DCSC group and 11 patients in the DCEH group. The mortality rates of the DC, DCSC and DCEH groups at the time of discharge were 22.2% (2/9), 0% (0/14) and 9.1% (1/11), respectively. At 6 months, the mortality rates in the DC, DCSC and DCEH groups increased to 44.4% (4/9), 21.4% (3/14) and 45.5% (5/11), respectively (P=0.367). The most common cause of death after discharge was pneumonia (8 cases). Twelve cases (35.3%) achieved good neurological outcome (mRS 0-3) at 6 months. The proportions of good neurological outcome in the DC, DCSC and DCEH groups were 22.2% (2/9 cases), 42.9% (6/14 cases) and 36.4% (4/11), respectively. The DCSC group seemed to have higher proportion of good outcomes, but there was no significant difference between groups (p=0.598). Among survivors, endovascular hypothermia had a higher proportion of good outcome, still without significant difference (DC group, 2/5 cases, 40.0%; DCSC group, 6/11 cases, 54.5%; DCEH group, 4/6 cases, 66.7%; p=0.696). The incidence of complications in the DCEH group was higher than those of the DC and DCSC groups (18.9%, 12.0%, and 12.1%, respectively; P=0.025).Conclusions: There is still no evidence to confirm that hypothermia further reduces long-term mortality and improves neurological outcomes in LHI patients with DC. However, there is a trend to benefit survivors from hypothermia. A local cooling method may be a better option for DC patients, which has little impact on systematic complications.Clinical Trial Registration - Decompressive Hemicraniectomy Combined Hypothermia in Malignant Middle Cerebral Artery Infarct, ChiCTR-TRC-12002698. Registered 11 Oct 2012- Retrospectively registered, URL: http://www.chictr.org.cn.

scholarly journals Cranioplasty Flap Lifting Caused by Intracranial Hypertension Literature Review

2021 ◽  
Vol 2 (3) ◽  
pp. 136-138
Author(s):  
Yakhya CISSE ◽  
Jean Michel NZISABIRA ◽  
Abdoulaye DIOP ◽  
Ansoumane DONZO ◽  
Louncény Fatoumata BARRY ◽  
...  
Keyword(s):  
Literature Review ◽  
Medical Treatment ◽  
Intracranial Hypertension ◽  
Bone Defect ◽  
Decompressive Craniectomy ◽  
Clinical Relevance ◽  
Severe Head Trauma ◽  
Review Of The Literature ◽  
Neurosurgical Technique ◽  
Postoperative Hydrocephalus

Cranioplasty is a neurosurgical technique that replaces a bone defect in the skull with hard replacement tissue. It is indicated in particular after a decompressive craniectomy performed in severe head trauma in order to control intracranial hypertension refractory to medical treatment. Cranioplasty is sometimes associated with a significant number of complications, including hydrocephalus. In this article, we report the case of a cranioplasty flap lifting on intracranial hypertension following postoperative hydrocephalus and discuss the clinical relevance with a review of the literature.

scholarly journals Decompressive Craniectomy Combined With Mild Hypothermia in Patients With Large Hemispheric Infarction: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Linlin Fan ◽  
Yingying Su ◽  
Yan Zhang ◽  
Hong Ye ◽  
Weibi Chen ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Decompressive Craniectomy ◽  
Neurological Outcome ◽  
Mortality Rates ◽  
Target Temperature ◽  
Good Neurological Outcome ◽  
Neurological Outcomes ◽  
Significant Difference ◽  
Standard Medical Treatment ◽  
Hemispheric Infarction

Abstract BackgroundTo investigate the effects of decompressive craniectomy (DC) combined with hypothermia treatment on mortality and neurological outcomes in patients with large hemispheric infarction (LHI).MethodsPatients within 48 hours of symptom onset were randomized to the following three groups: the DC group, the DC plus head surface cooling (DCSC) group and the DC plus endovascular hypothermia (DCEH) group. Patients in the DC group were given standard medical treatment with a normothermic target temperature. Patients in the DCSC group received standard medical treatment plus 24-hour ice cap on the head for 7 days. Patients in the DCEH group were given standard medical treatment plus endovascular hypothermia with a target temperature of 34 °C. The primary end-points were mortality and modified Rankin Scale (mRS) score at 6 months.ResultsThere were 9 patients in the DC group, 14 patients in the DCSC group and 11 patients in the DCEH group. The mortality rates of the DC, DCSC and DCEH groups at the time of discharge were 22.2% (2/9), 0% (0/14) and 9.1% (1/11), respectively. At 6 months, the mortality rates in the DC, DCSC and DCEH groups increased to 44.4% (4/9), 21.4% (3/14) and 45.5% (5/11), respectively (P = 0.367). The most common cause of death after discharge was pneumonia (8 cases). Twelve cases (35.3%) achieved good neurological outcome (mRS 0–3) at 6 months. The proportions of good neurological outcome in the DC, DCSC and DCEH groups were 22.2% (2/9 cases), 42.9% (6/14 cases) and 36.4% (4/11), respectively. The DCSC group seemed to have higher proportion of good outcomes, but there was no significant difference between groups (p = 0.598). Among survivors, endovascular hypothermia had a higher proportion of good outcome, still without significant difference (DC group, 2/5 cases, 40.0%; DCSC group, 6/11 cases, 54.5%; DCEH group, 4/6 cases, 66.7%; p = 0.696). The incidence of complications in the DCEH group was higher than those of the DC and DCSC groups (18.9%, 12.0%, and 12.1%, respectively; P = 0.025).ConclusionsThere is still no evidence to confirm that hypothermia further reduces long-term mortality and improves neurological outcomes in LHI patients with DC. However, there is a trend to benefit survivors from hypothermia. A local cooling method may be a better option for DC patients, which has little impact on systematic complications.Clinical Trial Registration-Decompressive Hemicraniectomy Combined Hypothermia in Malignant Middle Cerebral Artery Infarct, ChiCTR-TRC-12002698. Registered 11 Oct 2012- Retrospectively registered,URL: http://www.chictr.org.cn.

scholarly journals Evaluation of cerebrospinal fluid flow dynamic changes in patients with idiopathic intracranial hypertension using phase contrast cine MR imaging

2020 ◽  
Vol 56 (1) ◽  
Author(s):  
Tamer Belal ◽  
Abd-Elhalim Al Tantawy ◽  
Fatema Mohamed Sherif ◽  
Alshaimaa Ramadan
Keyword(s):  
Cerebrospinal Fluid ◽  
Medical Treatment ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Phase Contrast ◽  
Cine Mri ◽  
Mean Flow ◽  
Csf Flow ◽  
Flow Dynamic ◽  
Dynamic Changes

Abstract Background Idiopathic intracranial hypertension (IIH) mainly affects overweight women in the middle age period. The pathophysiology of IIH stays unclear, but suggested mechanisms include excess CSF production, reduced CSF absorption, increased brain water content, and increased cerebral venous pressure Objectives To assess the cerebrospinal fluid (CSF) flow dynamic changes in aqueduct of Sylvius in patients of idiopathic intracranial hypertension (IIH) with new MRI technique: phase contrast cine MRI (PCC-MRI). Methods Thirty patients diagnosed with idiopathic intracranial hypertension were divided into 3 groups according to treatment options (no treatment, medical treatment, and medical treatment with repeated lumbar tapping). CSF flow data were evaluated by phase contrast cine MRI. Results PCC-MRI parameters were significantly higher in group who was on medical treatment (group II) than other groups. The sensitivity of PCC MRI parameters ranged from 56.7 (stroke volume (SV) and mean flow (MF)) to 83.3% (peak systolic velocity (PSV)). A statistically significant difference was found for the mean flow value (p 0.039) between the control group and IIH patients. Conclusion The most specific CSF flowmetry parameter detected to help diagnosis of IIH is mean flow especially among early discovered patients. PCC MRI can be used as non-invasive technique for diagnosis of IIH and treatment follow-up.

scholarly journals Decompressive craniectomy for traumatic intracranial hypertension: application in children

2017 ◽  
Vol 33 (10) ◽  
pp. 1745-1750 ◽  
Author(s):  
Adam M. H. Young ◽  
Angelos G. Kolias ◽  
Peter J. Hutchinson
Keyword(s):  
Intracranial Hypertension ◽  
Decompressive Craniectomy

scholarly journals Bowel Ischemia from Heat Stroke: A Rare Presentation of an Uncommon Complication

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Umair Masood ◽  
Anuj Sharma ◽  
Wajihuddin Syed ◽  
Divey Manocha
Keyword(s):  
Heat Stroke ◽  
Kidney Injury ◽  
Bowel Ischemia ◽  
Ascending Colon ◽  
Rare Presentation ◽  
Early Presentation ◽  
Adequate Hydration ◽  
Unique Aspect ◽  
Bowel Movements ◽  
Uncommon Complication

A healthy 27-year-old female presented to the hospital after she collapsed an hour into her first marathon run on a hot humid day. On presentation, she was hyperthermic, encephalopathic, tachycardic, and hypotensive. On admission, she was found to have lactic acidosis, rhabdomyolysis, and acute kidney injury and was treated with cold normal saline and cooling blankets. She subsequently started having abdominal pain and bloody bowel movements. Computed tomography of the abdomen revealed ascending colon thickening. Furthermore, her lab findings showed transaminitis and elevated coagulation parameters. Due to the acute hypotensive state from the heat stroke, patient had developed bowel ischemia, ischemic hepatitis, and disseminated intravascular coagulation, all of which are uncommon complications of heat stroke. She was managed aggressively with intravenous fluid hydration with resolution of her symptoms over the course of 4 days. In addition to the uncommon complications, early presentation of this bowel ischemia despite adequate hydration in such a healthy individual is another unique aspect of the case.

Decompressive craniectomy and duraplasty for refractory intracranial hypertension in head injury

2008 ◽  
Vol 25 (Supplement 43) ◽  
pp. 8
Author(s):  
M. Souissi ◽  
W. Trabelsi ◽  
Z. Zaghdoudi ◽  
M. Soussi ◽  
N. Baffoun ◽  
...  
Keyword(s):  
Head Injury ◽  
Intracranial Hypertension ◽  
Decompressive Craniectomy

scholarly journals Clinical Effectiveness of Cardiocytoprotective Therapy in Patients with Acute Coronar Syndrome (ACS) – Myocardial Infarction (MI), Who Were Performed Balloon Angioplasty and Coronary Artery Stenting

2019 ◽  
Vol 25 (1) ◽  
Author(s):  
Mykola Shved ◽  
Lesia Tsuglevych ◽  
Svitlana Heryak
Keyword(s):  
Medical Treatment ◽  
Clinical Effectiveness ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Additional Treatment ◽  
Functional Improvement ◽  
Control Group ◽  
Restorative Treatment ◽  
Coronary Syndrome ◽  
Standard Medical Treatment

The aim of the study was to increase the efficiency of restorative treatment of patients with Acute Coronary Syndrome (Miocardial Infarction) by incorporating the protocol therapy for the course of parenteral use of L-arginine and L-carnitine (Tivorel). It has been determined that patients with ACS (MI) after percutaneous coronary intervention often develop reperfusion syndrome with manifestations of left ventricular insufficiency and rhythm disturbances. Substantial clinical and functional improvement was noted under the influence of standard medical treatment in patients of control group. At the same time postinfarction remodeling with systolic and diastolic function of the heart, with the development of heart failure syndrome and endothelial dysfunction of blood vessels, and also remained resistant to extrasystole therapy, progressed. Patients in the experimental group under the influence of complex medical treatment with the inclusion of L-arginine and L-carnitine marked a significant decrease in the frequency of violations of rhythm and conduction for the second day of observation, as well as a decrease in the manifestations of post-infarction remodeling of LV, which ultimately manifested a significant improvement in myocardial contractility (EF increased by 13%) and decreased diastolic dysfunction. Improvement of the inotropic function of the heart and a significant reduction in the frequency and severity of reperfusion arrhythmias was achieved precisely due to cardiometabolic effects of L-carnitine. In addition, in patients undergoing additional treatment with L-arginine and L-carnitine after 10 days of treatment, the activity of ET-1 was significantly lowered and the concentration of nitrogen oxide metabolites in the blood plasma increased and reach the level of healthy subjects (p>0.05). So, they recovered the endothelial function of the vessels.

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