Intracranial pressure dynamics and cerebral vasomotor reactivity in community-acquired bacterial meningitis during neurointensive care

OBJECTIVE Community-acquired bacterial meningitis (CABM) is a severe condition associated with high mortality. In this study the first aim was to evaluate the incidence of intracranial pressure (ICP) insults and disturbances in cerebral vasomotor reactivity and the second aim was to evaluate the management and clinical outcome of CABM patients treated in the neurointensive care unit (NICU). METHODS CABM patients who were treated in the NICU of Uppsala University Hospital, Sweden, during 2008–2020 were included in the study. Data on demographics, admission variables, treatment, ICP dynamics, vasomotor reactivity, and short-term clinical outcome were evaluated in these patients. RESULTS Of 97 CABM patients, 81 (84%) received ICP monitoring, of whom 22% had ICP > 20 mm Hg during 5% or more of the monitoring time on day 1, which decreased to 9% on day 3. For those patients with ICP monitoring, 46% required CSF drainage, but last-tier ICP treatment, including thiopental (4%) and decompressive craniectomy (1%), was rare. Cerebral vasomotor reactivity was disturbed, with a mean pressure reactivity index (PRx) above 0.2 in 45% of the patients on day 1, and remained high for the first 3 days. In total, 81 (84%) patients had a favorable outcome (Glasgow Coma Scale motor score [GCS M] 6) at discharge, 9 (9%) patients had an unfavorable outcome (GCS M < 6) at discharge, and 7 (7%) patients died in the NICU. Those with favorable outcome had significantly better cerebral vasomotor reactivity (lower PRx) than the two other outcome groups (p < 0.01). CONCLUSIONS Intracranial hypertension was frequent following severe CABM and CSF drainage was often sufficient to control ICP. Cerebral vasomotor reactivity was commonly disturbed and associated with poor outcome. Clinical outcome was slightly better than in earlier studies.

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Intracranial Pressure Dynamics and Cerebral Vasomotor Reactivity in Coronavirus Disease 2019 Patient With Acute Encephalitis

Critical Care Explorations ◽

10.1097/cce.0000000000000197 ◽

2020 ◽

Vol 2 (8) ◽

pp. e0197 ◽

Cited By ~ 2

Author(s):

Teodor Svedung Wettervik ◽

Eva Kumlien ◽

Elham Rostami ◽

Timothy Howells ◽

Magnus von Seth ◽

...

Keyword(s):

Intracranial Pressure ◽

Vasomotor Reactivity ◽

Acute Encephalitis ◽

Cerebral Vasomotor Reactivity ◽

Pressure Dynamics

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ASSESSMENT OF ZERO DRIFT IN THE CODMAN INTRACRANIAL PRESSURE MONITOR

Neurosurgery ◽

10.1227/01.neu.0000328392.98602.5a ◽

2009 ◽

Vol 64 (1) ◽

pp. 94-99 ◽

Cited By ~ 25

Author(s):

Yahia Z. Al-Tamimi ◽

Adel Helmy ◽

Seb Bavetta ◽

Stephen J. Price

Keyword(s):

Intracranial Pressure ◽

Interquartile Range ◽

Zero Drift ◽

Neurointensive Care ◽

Icp Monitoring ◽

Pressure Monitor ◽

Wide Range ◽

Neurosurgical Patients

Abstract OBJECTIVE Intraparenchymal monitoring devices play an important role in the daily management of head injury and other critically ill neurosurgical patients. Although zero drift data exist for the Camino system (Camino Laboratories, San Diego, CA), only in vitro data exist for the Codman system (Codman and Shurtleff, Inc., Raynham, MA). The aim of this study was to assess the extent of zero drift for the Codman intracranial pressure (ICP) monitor in patients being monitored in 2 neurointensive care units. METHODS This was a prospective study conducted at 2 neurointensive care units. Eighty-eight patients who required ICP monitoring and who presented to the 2 neurosurgical departments, Center 1 (n = 48) and Center 2 (n = 40), were recruited for participation. The duration of ICP monitoring was noted, as was the resultant pressure reading in normal saline on removing the ICP monitor (zero drift). RESULTS The median absolute zero drift for the group was 2.0 mm Hg (interquartile range, 1–3 mm Hg). The median time in situ was 108 hours (interquartile range, 69–201 hours). There was a positive correlation between the drift and time of the probe spent in situ (Spearman's correlation coefficient = 0.342; P = 0.001). Of the readings, 20 and 2% showed a drift greater than 5 and 10 mm Hg in magnitude, respectively. CONCLUSION These data demonstrate that a small amount of zero drift exists in ICP monitors and that this drift increases with time. The wide range in the data demonstrates that some drift readings are quite excessive. This reinforces the school of thought that, although ICP readings contribute significantly to the management of neurosurgical patients, they should be interpreted carefully and in conjunction with clinical and radiological assessment of patients.

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CEREBRAL VASOMOTOR REACTIVITY IN FIBROMYALGIA PATIENTS AND ITS RELATIONSHIP TO CENTRAL NEUROPATHIC PAIN

10.26226/morressier.5ab3c880a874c6002655906c ◽

2018 ◽

Author(s):

Sibel Guler

Keyword(s):

Neuropathic Pain ◽

Central Neuropathic Pain ◽

Vasomotor Reactivity ◽

Cerebral Vasomotor Reactivity

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In Hyperacute Recanalization Therapy, Early Hospital Arrival Improves Outcome in Patients with Large Artery Occlusion

European Neurology ◽

10.1159/000490461 ◽

2018 ◽

Vol 79 (5-6) ◽

pp. 335-341

Author(s):

Junya Aoki ◽

Kentaro Suzuki ◽

Satoshi Suda ◽

Seiji Okubo ◽

Masahiro Mishina ◽

...

Keyword(s):

Regression Analysis ◽

Clinical Outcome ◽

Multivariate Regression ◽

Intravenous Thrombolysis ◽

Multivariate Regression Analysis ◽

Artery Occlusion ◽

Favorable Outcome ◽

Large Artery ◽

Independent Factor ◽

Hospital Arrival

Background: It is unknown whether the effect of onset-to-door (OTD) time on clinical outcomes differs between patients with and without large artery occlusion (LAO) who undergo hyperacute recanalization therapy. Methods: Hyperacute recanalization therapy includes intravenous thrombolysis tissue-plasminogen activator (tPA), and endovascular therapy (EVT). Favorable clinical outcome was defined as modified Rankin Scale of ≤2 at discharge. Results: Among 164 patients, 117 (71%) patients received tPA, 86 (52%) received EVT, and 39 (24%) received tPA and EVT. One hundred and fifteen patients (70%) were classified into the LAO group and 49 (30%) into the non-LAO group. In the total cohort, multivariate regression analysis showed OTD time (OR 0.809 [95% CI 0.693–0.944], p = 0.007) was an independent factor related to the favorable outcome. Similarly, among patients with LAO, OTD was an independent negative factor for the favorable outcome (0.779 [0.646–0.940], p = 0.009). On the contrary, OTD was not associated with the favorable outcome (1.5 [0.7–2.5] vs. 1.7 [1.1–3.2], p = 0.155) in patients without LAO. This was confirmed with multivariate regression analysis, which did not show OTD to be an independent factor for the favorable outcome (0.900 [0.656–1.236], p = 0.516). Conclusion: The effect of early hospital arrival on clinical outcome differed between patients with and without LAO.

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Abstract WP68: Tissue Type Plasminogen Activator (t-PA) and Edaravone Combination Therapy Study (YAMATO Study)

Stroke ◽

10.1161/str.47.suppl_1.wp68 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Junya Aoki ◽

Kazumi Kimura ◽

Norifumi Metoki ◽

Yohei Tateishi ◽

Kenichi Todo ◽

...

Keyword(s):

Clinical Outcome ◽

Arterial Occlusion ◽

Artery Occlusion ◽

Free Radical Scavenger ◽

Favorable Outcome ◽

Tissue Type ◽

Radical Scavenger ◽

Stroke Patients ◽

Symptomatic Intracerebral Hemorrhage ◽

Favorable Clinical Outcome

Introduction&Hypothesis: The aim of the present study was to investigate whether administration of edaravone, a free radical scavenger, before or during t-PA administration can increase the rate of early recanalization and improve the clinical outcome in stroke patients with major arterial occlusion. Methods: YAMATO study is an investigator initiated, multicenter (17 hospitals in Japan), prospective, randomized, open labeled study. Acute stroke patients with horizontal (M1) or vertical (M2) portion of the middle cerebral artery occlusion within 4.5 h of onset were studied. The subjects were randomly allocated to the early edaravone (early-E) group (intravenous edaravone [30 mg] was started before or during t-PA administration) and the late edaravone (late-E) group (edaravone was started after t-PA administration). Primary outcome, defined as any early recanalization 1h after t-PA therapy. Secondary outcomes included the rate of the significant recanalization, defined as ≥50% of the territory of the occluded artery on magnetic resonance angiography, or the thrombolysis in cerebral infarction score ≥2b on digital subtraction angiography as well as the incidence of symptomatic intracerebral hemorrhage (sICH), and the favorable clinical outcome (modified Rankin scale [mRS] of 0-2) at 3 months after onset. Results: One-hundred and sixty-six patients (96 men; median age [interquartile range], 78 [69-85] years) were randomized 1:1 to either the early-E group or the late-E group. Twenty-three (13.9%) had proximal M1 occlusion; 60 (36.1%), distal M1 occlusion; 83 (50%), M2 occlusion. Early recanalization was similarly observed in the early-E group and in the late-E group (53.1% vs. 53.0%, P=1.000). The rate of significant recanalization was also similar between the 2 groups (27.2% vs. 33.7%, p=0.399). sICH was occurred in 4 (4.8%) patients in the early-E group and in 2 (2.4%) in the late-E group (p=0.682). Among the 144 patients who were pre-morbid mRS of 0-2 and eligible for 3 months assessment, favorable outcome was seen in 53.9% in the early-E group and 57.4% in the late-E group (p=0.738) Conclusions: The timing of the edaravone infusion should not affect the rate of early recanalization, sICH, or favorable outcome after t-PA therapy.

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Subcortical Infarctions, Transcranial Doppler, and Cerebral Vasomotor Reactivity

Archives of Neurology ◽

10.1001/archneur.58.4.551 ◽

2001 ◽

Vol 58 (4) ◽

Author(s):

Douglas A. Dulli

Keyword(s):

Transcranial Doppler ◽

Vasomotor Reactivity ◽

Cerebral Vasomotor Reactivity

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Recanalization and Angiographic Reperfusion Are Both Associated with a Favorable Clinical Outcome in the IMS III Trial

Interventional Neurology ◽

10.1159/000446749 ◽

2016 ◽

Vol 5 (3-4) ◽

pp. 118-122 ◽

Cited By ~ 8

Author(s):

Marie L. Schmitz ◽

Sharon D. Yeatts ◽

Thomas A. Tomsick ◽

David S. Liebeskind ◽

Achala Vagal ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Scale Score ◽

Predictive Accuracy ◽

Favorable Outcome ◽

Modified Rankin Scale ◽

Arterial Tree ◽

Stroke Treatment ◽

Optimal Thresholds ◽

Favorable Clinical Outcome

Background: Prompt revascularization is the main goal of acute ischemic stroke treatment. We examined which revascularization scale - reperfusion (modified Treatment in Cerebral Infarctions, mTICI) or recanalization (Arterial Occlusive Lesion, AOL) - better predicted the clinical outcome in ischemic stroke participants treated with endovascular therapy (EVT). Additionally, we determined the optimal thresholds for the predictive accuracy of each scale. Methods: We included participants from the Interventional Management of Stroke (IMS) III trial with complete occlusion in the internal carotid artery terminus or proximal middle cerebral artery (M1 or M2) who completed EVT within 7 h of symptom onset. The abilities of the AOL and mTICI scales to predict a favorable outcome (defined as a modified Rankin Scale score of 0-2 at 3 months) were compared by receiver operating characteristic analyses. The maximal sensitivity and specificity for each revascularization scale were established. Results: Among 240 participants who met the study inclusion criteria, 79 (33%) achieved a favorable outcome. Higher scores of mTICI and AOL increased the likelihood of a favorable outcome (2.7% with mTICI 0 vs. 83.3% with mTICI 3, and 3.0% with AOL 0 vs. 43% with AOL 3). The accuracy of mTICI reperfusion and AOL recanalization for a favorable outcome prediction was similar, with optimal thresholds of mTICI 2b/3 and AOL 3, respectively. Conclusion: Reperfusion (mTICI) and recanalization (AOL) predicted a favorable clinical outcome with comparable accuracy in ischemic stroke participants treated with EVT. Optimal revascularization goals to maximize clinical outcome (modified Rankin Scale score of 0-2) consisted of complete recanalization (AOL 3) and reperfusion of at least 50% of the arterial tree of the symptomatic artery (mTICI 2b/3) in the IMS III trial setting.

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The preoperative incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis is underestimated in the literature

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.8.peds1425 ◽

2014 ◽

Vol 14 (6) ◽

pp. 674-681 ◽

Cited By ~ 56

Author(s):

Steven A. Wall ◽

Gregory P. L. Thomas ◽

David Johnson ◽

Jo C. Byren ◽

Jayaratnam Jayamohan ◽

...

Keyword(s):

Intracranial Pressure ◽

Nonoperative Management ◽

Raised Intracranial Pressure ◽

Corrective Surgery ◽

Icp Monitoring ◽

Noninvasive Method ◽

Radiological Findings ◽

Indication For Surgery ◽

Sagittal Craniosynostosis ◽

Significant Difference

Object The presence of raised intracranial pressure (ICP) in untreated nonsyndromic, isolated sagittal craniosynostosis (SC) is an important functional indication for surgery. Methods A retrospective review was performed of all 284 patients presenting with SC to the Oxford Craniofacial Unit between 1995 and 2010. Results Intraparenchymal ICP monitoring was performed in 39 children following a standard unit protocol. Monitoring of ICP was offered for all patients in whom nonoperative management was considered on the basis of minimal deformity or in cases in which parents were reluctant to agree to corrective surgery. These patients presented at an older age than the rest of the cohort (mean age 56 months), with marked scaphocephaly (16/39, 41%), mild scaphocephaly (11, 28%), or no scaphocephalic deformity (12, 31%). Raised ICP was found in 17 (44%) patients, with no significant difference in its incidence among the 3 different deformity types. Raised ICP was not predicted by the presence of symptoms of ICP or developmental delay or by ophthalmological or radiological findings. Conclusions The incidence of raised ICP in SC reported here is greater than that previously published in the literature. The lack of a reliable noninvasive method to identify individuals with elevated ICP in SC mandates consideration of intraparenchymal ICP monitoring in all patients for whom nonoperative management is contemplated.

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