The Fontogram: A Noninvasive Intracranial Pressure Monitor

PEDIATRICS ◽  
1977 ◽  
Vol 60 (5) ◽  
pp. 721-725
Author(s):  
James H. Salmon ◽  
Waleed Hajjar ◽  
Henrietta S. Bada
Keyword(s):  
Intracranial Pressure ◽  
Correlation Coefficient ◽  
Newborn Infants ◽  
Pressure Monitor ◽  
Direct Measurements ◽  
Mean Pressure ◽  
The Mean ◽  
Increased Icp ◽  
Clinical Cases

The applanation transducer was used to measure intracranial pressure (ICP) through the intact fontanel. The method is painless, rapid, and accurate. The pressures recorded with this fontogram were correlated with direct measurements of ICP. The correlation coefficient of the 21 paired determinations was .98—a very good correlation. Fontanel pressure was determined in 35 normal newborn infants. The mean pressure was 7.37 mm Hg with an SD of ± 1.45 (range, 3.5 to 9.5 mm Hg). Three clinical cases are presented to illustrate the usefulness of this apparatus in the detection of increased ICP and in monitoring the effectiveness of treatment.

scholarly journals Intracranial pressure elevations in diffuse axonal injury: association with nonhemorrhagic MR lesions in central mesencephalic structures

2019 ◽  
Vol 131 (2) ◽  
pp. 604-611
Author(s):  
Sami Abu Hamdeh ◽  
Niklas Marklund ◽  
Anders Lewén ◽  
Tim Howells ◽  
Raili Raininko ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Linear Regression ◽  
Axonal Injury ◽  
Diffuse Axonal Injury ◽  
Related Factors ◽  
Severe Tbi ◽  
The Mean ◽  
And Diffusion ◽  
Lesion Localization ◽  
Increased Icp

OBJECTIVEIncreased intracranial pressure (ICP) in patients with severe traumatic brain injury (TBI) with diffuse axonal injury (DAI) is not well defined. This study investigated the occurrence of increased ICP and whether clinical factors and lesion localization on MRI were associated with increased ICP in patients with DAI.METHODSFifty-two patients with severe TBI (median age 24 years, range 9–61 years), who had undergone ICP monitoring and had DAI on MRI, as determined using T2*-weighted gradient echo, susceptibility-weighted imaging, and diffusion-weighted imaging (DWI) sequences, were enrolled. The proportion of good monitoring time (GMT) with ICP > 20 mm Hg during the first 120 hours postinjury was calculated and associations with clinical and MRI-related factors were evaluated using linear regression.RESULTSAll patients had episodes of ICP > 20 mm Hg. The mean proportion of GMT with ICP > 20 mm Hg was 5%, and 27% of the patients (14/52) spent more than 5% of GMT with ICP > 20 mm Hg. The Glasgow Coma Scale motor score at admission (p = 0.04) and lesions on DWI sequences in the substantia nigra and mesencephalic tegmentum (SN-T, p = 0.001) were associated with the proportion of GMT with ICP > 20 mm Hg. In multivariable linear regression, lesions on DWI sequences in SN-T (8% of GMT with ICP > 20 mm Hg, 95% CI 3%–13%, p = 0.004) and young age (−0.2% of GMT with ICP > 20 mm Hg, 95% CI −0.07% to −0.3%, p = 0.002) were associated with increased ICP.CONCLUSIONSIncreased ICP occurs in approximately one-third of patients with severe TBI who have DAI. Age and lesions on DWI sequences in the central mesencephalon (i.e., SN-T) are associated with elevated ICP. These findings suggest that MR lesion localization may aid prediction of increased ICP in patients with DAI.

Evaluation of the Relationship Between NIRS (Near-Infrared Spectroscopy) and Optic Nerve Sheath Diameter Measurement in Children with Increased Intracranial Pressure: A Pilot Study

2020 ◽  
Author(s):  
Didar Arslan ◽  
Dinçer Yildizdas ◽  
Özden ÖZGÜR HOROZ ◽  
Nagehan Aslan ◽  
Faruk İNCECİK
Keyword(s):  
Infrared Spectroscopy ◽  
Optic Nerve ◽  
Intracranial Pressure ◽  
Near Infrared ◽  
Optic Nerve Sheath Diameter ◽  
Increased Intracranial Pressure ◽  
Mean Values ◽  
Nerve Sheath ◽  
The Mean ◽  
Increased Icp

Abstract Background: The increased intracranial pressure (ICP) syndrome may emerge depending on many different neurological factors and the early diagnosis and treatment are important for the prevention of neurologic damage and related mortality. In recent years, the follow-up of increased ICP with non-invasive methods has been increasing. In this study, our objective was to determine the significance of ONSD (Optic Nerve Sheath Diameter) and NIRS (Near-Infrared Spectroscopy) in children with increased ICP and any possible correlation between ONSD and NIRS. Methods: Patients who were hospitalized in our pediatric ICU at Çukurova University Medical Faculty between June 2018 and June 2019 due to the suspicion of increased ICP were included in this study. The demographic characteristics of patients, diagnosis at admission, results of the cranial CT and MRI examinations, and results of the simultaneous ONSD and NIRS measurements were recorded. Results: A total of 36 patients were included in our study. With respect to the diagnosis, non-traumatic causes were at the forefront in 30 patients (83.3%), and the most common causes were meningoencephalitis (n=9; 25%) and non-traumatic bleeding (n=7; 19.4%). Six of the patients were under the age of one year (16.7%), and the mean values of ONSD and NIRS were 4.8±0.7 mm and 71.1±12.4% respectively in this group. Fourteen patients were in the one to ten year age group and the mean values of ONSD and NIRS were 6.1±0.6 mm and 72.7±9.3% respectively. Sixteen patients were over ten years of age (44.4%), and the mean values of ONSD and NIRS were 5.6±0.7 mm and 74.2±16% respectively. There was no correlation between the ONSD and NIRS values (r:0.3; p=0.07).Conclusion: Our study showed that ONSD measurements were helpful in children with increased ICP and reflected the increase in ICP. However, our study also demonstrated that ONSD was not in correlation with the NIRS monitoring. We believe that there is a need for further studies focused on the use of ONSD and NIRS in the monitoring of increased ICP.

scholarly journals Evaluation of the relationship between NIRS (near-infrared spectroscopy) and optic nerve sheath diameter measurement in children with increased intracranial pressure: a pilot study

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Didar Arslan ◽  
Dinçer Yıldızdaş ◽  
Özden Özgür Horoz ◽  
Nagehan Aslan ◽  
Faruk İncecik
Keyword(s):  
Infrared Spectroscopy ◽  
Optic Nerve ◽  
Intracranial Pressure ◽  
Near Infrared ◽  
Optic Nerve Sheath Diameter ◽  
Increased Intracranial Pressure ◽  
Mean Values ◽  
Nerve Sheath ◽  
The Mean ◽  
Increased Icp

Abstract Background The increased intracranial pressure (ICP) syndrome may emerge depending on many different neurological factors and the early diagnosis and treatment are important for the prevention of neurologic damage and related mortality. In recent years, the follow-up of increased ICP with non-invasive methods has been rising. In this study, our objective was to determine the significance and any possible correlation between Optic Nerve Sheath Diameter (ONSD) and Near Infrared Spectroscopy (NIRS) in children with increased ICP. Methods Patients who were hospitalized in our pediatric ICU at Çukurova University Medical Faculty between June 2018 and June 2019 due to the suspicion of increased ICP were included in this study. The demographic characteristics of patients, diagnosis at admission, results of the cranial CT and MRI examinations, and results of the simultaneous ONSD and NIRS measurements were recorded. Results A total of 36 patients were included in our study. With respect to the diagnosis, non-traumatic causes were at the forefront in 30 patients (83.3%), and the most common causes were meningoencephalitis (n = 9; 25%) and non-traumatic bleeding (n = 7; 19.4%). Six of the patients were under the age of one year (16.7%), and the mean values of ONSD and NIRS were 4.8 ± 0.7 mm and 71.1 ± 12.4% respectively in this group. Fourteen patients were in the one to ten year age group and the mean values of ONSD and NIRS were 6.1 ± 0.6 mm and 72.7 ± 9.3% respectively. Sixteen patients were over ten years of age (44.4%), and the mean values of ONSD and NIRS were 5.6 ± 0.7 mm and 74.2 ± 16% respectively. There was no correlation between the ONSD and NIRS values (r:0.307; p = 0.068). Conclusion Our study showed that ONSD measurements were helpful in children with increased ICP and reflected the increase in ICP. However, our study also demonstrated that ONSD was not in correlation with the NIRS monitoring. We believe that there is a need for further studies focused on the use of ONSD and NIRS in the monitoring of increased ICP.

scholarly journals Pulsatility Index Reflects Intracranial Pressure Better than Resistive Index in Patients with Clinical Features of Intracranial Hypertension

2020 ◽  
Vol 11 (01) ◽  
pp. 144-150
Author(s):  
Narender Kaloria ◽  
Nidhi Bidyut Panda ◽  
Hemant Bhagat ◽  
Neha Kaloria ◽  
Shiv Lal Soni ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Correlation Coefficient ◽  
Roc Curve ◽  
Pulsatility Index ◽  
Pearson Correlation ◽  
Resistive Index ◽  
Third Ventriculostomy ◽  
Noninvasive Methods ◽  
The Mean ◽  
Better Than

Abstract Background The intracranial pressure (ICP) is measured through various noninvasive methods to overcome complications of invasive ICP monitoring. In this study, transcranial Doppler was used to measure pulsatility index (PI) and resistive index (RI) that were correlated with opening intraventricular ICP. The opening intraventricular ICP was measured with the placement of intraventricular catheter in lateral ventricle without loss of cerebrospinal fluid. Methods The prospective, observational study was conducted on 40 patients with clinical and radiological features of raised ICP who underwent either endoscopic third ventriculostomy or ventriculoperitoneal shunt surgery. The PI and RI were measured simultaneously with opening ICP measurements under general anesthesia. Both PI and RI were correlated with ICP by using Pearson correlation coefficient. The receiver operating characteristic (ROC) curve was used to get the optimal values of PI ad RI for corresponding ICP values. Results The mean PI was 1.01 ± 0.41 and mean RI was 0.59 ± 0.32. The mean opening ICP value was 21.81 ± 8.68 mm Hg. The correlation between PI and RI with ICP was a statistically significant with correlation coefficient of 0.697 and 0.503, respectively. The ROC curve shown statistically significant association between PI and ICP from 15 to 40 mm Hg, whereas the association between RI and ICP was from 15 to 25 mm Hg, with various sensitivity and specificity. Conclusion The opening intraventricular ICP correlated better with PI than RI in patients with features of raised ICP.

scholarly journals Mean value of B-mode optic nerve sheath diameter as an indicator of increased intracranial pressure: a systematic review and meta-analysis

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Lisandro Montorfano ◽  
Qian Yu ◽  
Stephen J. Bordes ◽  
Shankarapryan Sivanushanthan ◽  
Raul J. Rosenthal ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Mean Value ◽  
Cochrane Library ◽  
Clinical Settings ◽  
Increased Intracranial Pressure ◽  
The Mean ◽  
Increased Icp

Abstract Objectives Timely diagnosis and treatment of increased intracranial pressure can decrease morbidity and prevent mortality. The present meta-analysis aims to determine the mean value of the ONSD measured in patients with various elevated ICP etiologies under different clinical settings, as well as comparing the value of ONSD between patients with and without elevated ICP. Methods This meta-analysis complied with the Preferred Reporting Items for Systematic Reviews and Meta-analysis Statement8. PubMed, Embase, and Cochrane Library were searched to identify ONSD measured by US for patients with increased ICP from establishment to October 2020. Results A total of 779 patients with elevated ICP among 22 studies were included in the present meta-analysis. Studies were published between 2003 and 2020. Eighteen were comparative (18/22, 81.8%), and four were single-armed study (4/22, 18.2%). Twenty were prospective studies (20/22, 90.9%). There was moderate-to-high heterogeneity based on the prediction ellipse area and variance logit of sensitivity and specificity. Conclusions The mean value of the ONSD among patients diagnosed with increased ICP was 5.82 mm (95% CI 5.58–6.06 mm). Variations were observed based on etiology of intracranial hypertension, clinical settings where ONSD was measured, and standards for diagnosing intracranial hypertension. The US-ONSD among patient with elevated ICP was significantly higher than the normal control. Although a cut-off value is not clearly determined, these mean values can be implemented to evaluate the sensitivity and specificity of US-ONSD in diagnosing intracranial hypertension in future studies.

Effects of halothane and fentanyl anesthesia on resistance to reabsorption of CSF

1984 ◽  
Vol 60 (2) ◽  
pp. 252-256 ◽  
Author(s):  
Alan A. Artru
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Content Type ◽  
Ventriculocisternal Perfusion ◽  
Patients At Risk ◽  
The Mean ◽  
Spatial Compensation ◽  
Increased Icp ◽  
Fine Print ◽  
Cerebrospinal Fluid Volume

✓ Using the technique of ventriculocisternal perfusion, resistance to reabsorption of cerebrospinal fluid (Ra) was examined in dogs during anesthesia with halothane (0.8%) or fentanyl (3.0 µg ⋅ kg−1 ⋅ min−1 for 20 minutes, followed by 0.2 µg ⋅ kg−1 ⋅ min−1, intravenously). Compared to normal Ra in dogs (220 to 224 cm H2O⋅ ml−1⋅min−1), halothane increased Ra to 245 ± 2 cm H2O⋅ml−1⋅min−1 (mean ± standard error of the mean), and fentanyl decreased Ra to 114 ± 1 cm H2O⋅ml−1⋅min−1. Changes in Ra caused by halothane or fentanyl may contribute, in part, to changes in intracranial pressure (ICP) observed during prolonged anesthesia with these agents. Because decreased Ra improves spatial compensation by cerebrospinal fluid volume during increased ICP, fentanyl may be preferred over halothane in patients at risk because of increased ICP.

ICP MONITOR PLACEMENT STEPWISE EARLY DECOMPRESSIVE CRANIECTOMY FOR THE MANAGEMENT OF SEVERE TBI PATIENTS: A CASE REPORT

2018 ◽  
pp. 35-40
Author(s):  
Dirga Rachmad Aprianto ◽  
Achmad Kurniawan ◽  
Andhika Tomy Permana ◽  
Fadillah Putri Rusdi ◽  
Akbar Wido ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Case Report ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Intracranial Hemorrhage ◽  
Decompressive Craniectomy ◽  
Pressure Monitor ◽  
Severe Tbi ◽  
Gradual Release ◽  
Increased Icp

Introduction. Increased intracranial pressure (ICP) is a secondary event that mostly occurs following traumatic brain injury (TBI) and it correlates with poor outcome of the patients. Several studies have suggested that early decompressive craniectomy (DC; within 48 hours after injury) is recommended for severe TBI patients requiring removal of intracranial hemorrhage and early DC was able to reduce the complications of TBI caused by increased ICP. However, even early DC has been performed, increased ICP may still progress due to massive brain edema. Methods. We herein report a case report of patient admitted with severe TBI and intracranial hemorrhage. The patients were underwent DC and ICP monitor placement after the removal of the intracranial hemorrhage. During postoperative observation in ICU, the CSF of the patients was gradually drained if the ICP was over 15mmHg. Results. The ICP right after performed early DC was 30 cmH2O (22 mmHg). One day after surgery, the hemodynamic of the patient was stable and the GCS was 2X5 with the ICP of the patient was about 18 cmH2O. On day 2-5, patient was hemodynamically stable with improved GCS (3X5) and decreased of ICP (around 13-15 cmH2O). On day 6, the ICP monitor was removed and the patient discharged on day 19 after fully recovered. Conclusion. The placement of ICP monitor and the application of gradual release of CSF after DC might be helpful to reduce increased ICP in severe TBI patients, and thus reducing the morbidity and mortality.   Keywords: Traumatic brain injury, intracranial pressure monitor, decompressive craniectomy

scholarly journals Pressure Field Over Europe and North Atlantic Favourable for The Occurrence of Clear and Cloudy Days in Poland

2006 ◽  
Vol 12 (1) ◽  
pp. 55-65
Author(s):  
Elwira Żmudzka
Keyword(s):  
Correlation Coefficient ◽  
North Atlantic ◽  
Linear Correlation ◽  
Pressure Field ◽  
Mean Pressure ◽  
The Mean ◽  
Grid Nodes

Abstract In this paper, results of research concerning circulation conditions favouring the occurrence of clear and cloudy days in Poland are presented. An analysis of the mean pressure field over North Atlantic and Europe on such days was performed, differences between the mean pressure on such days and the mean pressure from all the days of the period 1966-2000 were determined. The pressure field was characterised by mean daily values taken from grid nodes from the area with φ 30°–70°N and λ 40°W–60°E (NCEP/NCAR database). The relation between the amount of cloudiness over Poland and pressure was estimated by means of linear correlation coefficient.

THE EFFECT OF ALTERATION OF THYROXINE BINDING CAPACITY ON THE DIALYZABLE AND ABSOLUTE FRACTIONS OF TRIIODOTHYRONINE IN CIRCULATION

1973 ◽  
Vol 72 (2) ◽  
pp. 265-271 ◽  
Author(s):  
J. H. Dussault ◽  
D. A. Fisher ◽  
J. T. Nicoloff ◽  
V. V. Row ◽  
R. Volpe
Keyword(s):  
Correlation Coefficient ◽  
Inverse Relationship ◽  
Binding Capacity ◽  
Hormone Concentration ◽  
Thyroxine Binding Globulin ◽  
Serum Thyroxine ◽  
A Value ◽  
The Mean ◽  
Male Subjects ◽  
Female Subjects

ABSTRACT In order to determine the effect of alterations in binding capacity of thyroxine binding globulin (TBG) on triiodothyronine (T3) metabolism, studies were conducted in 10 patients with idiopathically low (7 subjects) or elevated (3 subjects) TBG levels and 10 subjects given norethandrolone (7 male subjects) or oestrogen (3 female subjects). Measurements of serum thyroxine (T4) concentration, maximal T4 binding capacity, serum T3 concentration and per cent dialyzable T3 were conducted. Serum T3 was measured both by chemical and radioimmunoassay methods. In patients with idiopathically low TBG, the mean serum T4 concentration was low (2.4 μg/100 ml), the mean serum T3 level low (55 ng/100 ml), the mean per cent dialyzable T3 increased (0.52%), and the calculated free T3 concentration normal (186 pg/100 ml). In patients with idiopathically high TBG levels the mean T4 concentration was high (10.3 μg/100 ml), the mean T3 level slightly elevated (127 ng/100 ml), the% dialyzable T3 low (0.10%) and the calculated free T3 concentration low normal (123 pg/100 ml). The correlation coefficient between the per cent dialyzable T3 and maximal TBG binding capacity in the 20 subjects was 0.68, a value significant at the P < 0.01 level. Thus, alterations in binding capacity of TBG seem to influence T3 and T4 metabolism similarly; the inverse relationship between the % of dialyzable hormone and total hormone concentration tends to keep the absolue levels of free hormones stable.

scholarly journals Use and success evaluation of percutaneous aortic balloon valvuloplasty in different hemodynamic entities of severe aortic stenosis in the TAVR era

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Piayda ◽  
A Wimmer ◽  
H Sievert ◽  
K Hellhammer ◽  
S Afzal ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Pressure Gradient ◽  
Severe Aortic Stenosis ◽  
Primary Treatment ◽  
Low Flow ◽  
Mean Pressure ◽  
The Mean

Abstract Background In the era of transcatheter aortic valve replacement (TAVR), there is renewed interest in percutaneous balloon aortic valvuloplasty (BAV), which may qualify as the primary treatment option of choice in special clinical situations. Success of BAV is commonly defined as a significant mean pressure gradient reduction after the procedure. Purpose To evaluate the correlation of the mean pressure gradient reduction and increase in the aortic valve area (AVA) in different flow and gradient patterns of severe aortic stenosis (AS). Methods Consecutive patients from 01/2010 to 03/2018 undergoing BAV were divided into normal-flow high-gradient (NFHG), low-flow low-gradient (LFLG) and paradoxical low-flow low-gradient (pLFLG) AS. Baseline characteristics, hemodynamic and clinical information were collected and compared. Additionally, the clinical pathway of patients (BAV as a stand-alone procedure or BAV as a bridge to aortic valve replacement) was followed-up. Results One-hundred-fifty-six patients were grouped into NFHG (n=68, 43.5%), LFLG (n=68, 43.5%) and pLFLG (n=20, 12.8%) AS. Underlying reasons for BAV and not TAVR/SAVR as the primary treatment option are displayed in Figure 1. Spearman correlation revealed that the mean pressure gradient reduction had a moderate correlation with the increase in the AVA in patients with NFHG AS (r: 0.529, p&lt;0.001) but showed no association in patients with LFLG (r: 0.145, p=0.239) and pLFLG (r: 0.030, p=0.889) AS. Underlying reasons for patients to undergo BAV and not TAVR/SAVR varied between groups, however cardiogenic shock or refractory heart failure (overall 46.8%) were the most common ones. After the procedure, independent of the hemodynamic AS entity, patients showed a functional improvement, represented by substantially lower NYHA class levels (p&lt;0.001), lower NT-pro BNP levels (p=0.003) and a numerical but non-significant improvement in other echocardiographic parameters like the left ventricular ejection fraction (p=0.163) and tricuspid annular plane systolic excursion (TAPSE, p=0.066). An unplanned cardiac re-admission due to heart failure was necessary in 23.7% patients. Less than half of the patients (44.2%) received BAV as a bridge to TAVR/SAVR (median time to bridge 64 days). Survival was significantly increased in patients having BAV as a staged procedure (log-rank p&lt;0.001). Conclusion In daily clinical practice, the mean pressure gradient reduction might be an adequate surrogate of BAV success in patients with NFHG AS but is not suitable for patients with other hemodynamic entities of AS. In those patients, TTE should be directly performed in the catheter laboratory to correctly assess the increase of the AVA. BAV as a staged procedure in selected clinical scenarios increases survival and is a considerable option in all flow states of severe AS. (NCT04053192) Figure 1 Funding Acknowledgement Type of funding source: None

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