Demonstration of uneven distribution of intracranial pulsatility in hydrocephalus patients

2008 ◽  
Vol 109 (5) ◽  
pp. 912-917 ◽  
Author(s):  
Per K. Eide
Keyword(s):  
Rise Time ◽  
Wave Amplitude ◽  
Time Windows ◽  
External Ventricular Drainage ◽  
Brain Parenchyma ◽  
Uneven Distribution ◽  
Cerebral Ventricles ◽  
Time Coefficient ◽  
Intracranial Pulsatility ◽  
The Brain

Object Data from intracranial pressure (ICP) recordings in patients with hydrocephalus were reviewed to determine whether intracranial pulsatility within the cerebrospinal fluid (CSF) of cerebral ventricles (ICPLV) may differ from that within the brain parenchyma (ICPPAR), and whether pulsatility may differ between noncommunicating ventricles. Methods The authors retrieved data from recordings previously obtained in 7 patients with hydrocephalus (noncommunicating in 4 and communicating in 3) and shunt failure who received both an external ventricular drainage (EVD) and an ICP sensor as part of surveillance during intensive care. Simultaneous ICPLV and ICPPAR signals were available in 6 cases, and simultaneous signals from the lateral and fourth ventricles (ICPLV and ICP4V, respectively) were recorded in 1 case. The recordings with both signals were parsed into 6-second time windows. Pulsatility was characterized by the wave amplitude and rise time coefficient, and differences in pulsatility between the ICPLV and ICPPAR signals (6 cases) or ICPLV and ICP4V signals (1 case) were determined. Results There was uneven distribution of intracranial pulsatility in all 7 patients, shown as significantly elevated pulsatility (that is, higher wave amplitudes and rise time coefficients) within the ventricles (ICPLV) than within brain parenchyma (ICPPAR) in 6 patients, and significantly higher pulsatility in the fourth (ICP4V) than in the lateral (ICPLV) ventricles in 1 patient. Differences ≥1 mm Hg in ICP wave amplitude were found in 0.5–100% (median 9.4%) of observations in the 7 patients (total number of 6-second time windows, 68,242). Conclusions The present observations demonstrate uneven distribution of intracranial pulsatility in patients with hydrocephalus, higher pulse pressure amplitudes within the ventricular CSF (ICPLV) than within the brain parenchyma (ICPPAR). This may be one mechanism behind ventricular enlargement in hydrocephalus.

Do Complication Rates of Ventricular Drain Placement Differ between Twist Drill and Burr Hole in Acute Hydrocephalus?

2019 ◽  
Vol 80 (04) ◽  
pp. 277-284 ◽  
Author(s):  
Christine Brand ◽  
Andrej Pala ◽  
Wilhelm Kielhorn ◽  
Christian Rainer Wirtz ◽  
Thomas Kapapa
Keyword(s):  
External Ventricular Drainage ◽  
Brain Parenchyma ◽  
Burr Hole ◽  
Acute Subdural Hematoma ◽  
Complication Rates ◽  
Twist Drill ◽  
Acute Hydrocephalus ◽  
Duration Of Surgery ◽  
The Difference ◽  
The Brain

Objective The aim of the study was to compare two techniques for external ventricular drainage (EVD) placement with respect to their complication rates. Methods A retrospective descriptive study was performed to analyze all patients who had undergone EVD implantation for acute hydrocephalus between January 2010 and December 2013 with a focus on surgical technique and rate of complications. The burr hole technique (BHT) was used in one group and the twist-drill technique (TDT) in the other. Particular attention was paid to malposition, hemorrhage, and catheter-associated infection. Results A total of 350 consecutive patients underwent EVD implantation for acute hydrocephalus: BHT was performed in 201 and TDT in 147 of the patients, whereas in two patients the technique used was unknown. The overall infection rate was 6.3% (n = 22). Fourteen patients (4%) in the BHT group developed an infection compared with eight patients (9.5%) in the TDT group (p = 0.154). In 16 (4.5%) of all cases, postoperative computed tomography revealed catheter-induced hemorrhage.In one case (0.3%), surgery was necessary due to acute subdural hematoma. The difference between both techniques was not statistically significant (p = 0.343). In 44 (12.6%) of all cases, the position of the EVD tip was contralateral; in 36 (10.3%) of all cases, the EVD tip was in the brain parenchyma. The rate of malposition was 11.6% (n = 17) in the TDT group and 9.5% (n = 19) in the BHT group (p = 0.078). Conclusion Neither technique showed significantly different numbers in terms of infection, malposition, and hemorrhagic complications. EVD implantation using the TDT is an adequate method compared with BHT. The advantages of TDT are clear: the duration of surgery is shorter, the size of the wound is smaller, and the surgeon is not confined to the operating room.

scholarly journals A dynamic nonlinear relationship between the static and pulsatile components of intracranial pressure in patients with subarachnoid hemorrhage

2010 ◽  
Vol 112 (3) ◽  
pp. 616-625 ◽  
Author(s):  
Per K. Eide ◽  
Benjamin I. Rapoport ◽  
William B. Gormley ◽  
Joseph R. Madsen
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Pressure ◽  
Rise Time ◽  
Wave Amplitude ◽  
Time Windows ◽  
Optimal Monitoring ◽  
Compliance Curve ◽  
The Mean ◽  
The Relationship ◽  
Over Time

Object In the search for optimal monitoring and predictive tools in neurocritical care, the relationship of the pulsatile component of intracranial pressure (ICP) and the pressure itself has long been of great interest. Higher pressure often correlates with a higher pulsatile response to the heartbeat, interpreted as a type of compliance curve. Various mathematical approaches have been used, but regardless of the formula used, it is implicitly assumed that a reproducible curve exists. The authors investigated the stability of the correlation between static and pulsatile ICPs in patients with subarachnoid hemorrhage (SAH) who were observed for several hours by using data sets large enough to allow such calculations to be made. Methods The ICP recordings were obtained in 39 patients with SAH and were parsed into 6-second time windows (1,998,944 windows in 197 recordings). The ICP parameters were computed for each window as follows: static ICP was defined as the mean ICP, and pulsatile ICP was characterized by mean ICP wave amplitude, rise time, and rise time coefficient. Results The mean ICP and ICP wave amplitudes were simultaneously high or low (the expected correlation) in only ~ 60% of observations. Furthermore, static and pulsatile ICP correlated well only over short intervals; the degree of correlation weakened over periods of hours and was inconsistent across patients and within individual patients over time. Decorrelation originated with abrupt shifting and gradual drifting of mean ICP and ICP wave amplitude over several hours. Conclusions The relationship between the static and pulsatile components of ICPs changes over time. It evolves, even in individual patients, over a number of hours. This can be one reason the observation of high pulsatile ICP (indicative of reduced intracranial compliance) despite normal mean ICP that is seen in some patients with SAH. The meaning and potential clinical usefulness of such changes in the curves is uncertain, but it implies that clinical events result not only from moving further out on a compliance curve; in practice, the curve, and the biological system that underlies the curve, may itself change.

scholarly journals Macrophages and microglia: the cerberus of glioblastoma

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Alice Buonfiglioli ◽  
Dolores Hambardzumyan
Keyword(s):  
Tumor Cells ◽  
Innate Immune System ◽  
Tumor Heterogeneity ◽  
Expression Profiles ◽  
Brain Parenchyma ◽  
Innate Immune ◽  
Malignant Growth ◽  
Neoplastic Cells ◽  
Functional Roles ◽  
The Brain

AbstractGlioblastoma (GBM) is the most aggressive and deadliest of the primary brain tumors, characterized by malignant growth, invasion into the brain parenchyma, and resistance to therapy. GBM is a heterogeneous disease characterized by high degrees of both inter- and intra-tumor heterogeneity. Another layer of complexity arises from the unique brain microenvironment in which GBM develops and grows. The GBM microenvironment consists of neoplastic and non-neoplastic cells. The most abundant non-neoplastic cells are those of the innate immune system, called tumor-associated macrophages (TAMs). TAMs constitute up to 40% of the tumor mass and consist of both brain-resident microglia and bone marrow-derived myeloid cells from the periphery. Although genetically stable, TAMs can change their expression profiles based upon the signals that they receive from tumor cells; therefore, heterogeneity in GBM creates heterogeneity in TAMs. By interacting with tumor cells and with the other non-neoplastic cells in the tumor microenvironment, TAMs promote tumor progression. Here, we review the origin, heterogeneity, and functional roles of TAMs. In addition, we discuss the prospects of therapeutically targeting TAMs alone or in combination with standard or newly-emerging GBM targeting therapies.

scholarly journals Practical application of synthetic head models in real ballistic cases

2021 ◽  
Author(s):  
F. Riva ◽  
T. Fracasso ◽  
A. Guerra ◽  
P. Genet
Keyword(s):  
Soft Tissues ◽  
Spherical Model ◽  
Brain Parenchyma ◽  
Human Bone ◽  
Shape Model ◽  
The Difference ◽  
Open Shape ◽  
The Brain ◽  
Synthetic Models ◽  
Representative Material

AbstractIn shooting crimes, ballistics tests are often recommended in order to reproduce the wound characteristics of the involved persons. For this purpose, several “simulants” can be used. However, despite the efforts in the research of “surrogates” in the field of forensic ballistic, the development of synthetic models needs still to be improved through a validation process based on specific real caseworks. This study has been triggered by the findings observed during the autopsy performed on two victims killed in the same shooting incident, with similar wounding characteristics; namely two retained head shots with ricochet against the interior wall of the skull; both projectiles have been recovered during the autopsies after migration in the brain parenchyma. The thickness of the different tissues and structures along the bullets trajectories as well as the incident angles between the bullets paths and the skull walls have been measured and reproduced during the assemblage of the synthetic head models. Two different types of models (“open shape” and “spherical”) have been assembled using leather, polyurethane and gelatine to simulate respectively skin, bone and soft tissues. Six shots have been performed in total. The results of the models have been compared to the findings of post-mortem computed tomography (PMCT) and the autopsy findings.Out of the six shots, two perforated the models and four were retained. When the projectile was retained, the use of both models allowed reproducing the wounds characteristics observed on both victims in terms of penetration and ricochet behaviour. However, the projectiles recovered from the models showed less deformation than the bullets collected during the autopsies. The “open shape” model allowed a better controlling on the shooting parameters than the “spherical” model. Finally, the difference in bullet deformation could be caused by the choice of the bone simulant, which might under-represent either the strength or the density of the human bone. In our opinion, it would be worth to develop a new, more representative material for ballistic which simulates the human bone.

scholarly journals Primary Cranial Vault Lymphoma Extending between Subcutaneous Tissue and Brain Parenchyma without Skull Destruction after Mild Head Trauma: A Case Report and Literature Review

2021 ◽  
pp. 1118-1123
Author(s):  
Kengo Setta ◽  
Takaaki Beppu ◽  
Yuichi Sato ◽  
Hiroaki Saura ◽  
Junichi Nomura ◽  
...  
Keyword(s):  
Tumor Cells ◽  
Head Trauma ◽  
Dura Mater ◽  
Subcutaneous Tissue ◽  
Bone Destruction ◽  
B Cell Lymphoma ◽  
Brain Parenchyma ◽  
Skin Tumor ◽  
Cranial Vault ◽  
The Brain

Malignant lymphoma of the head rarely arises outside of the brain parenchyma as primary cranial vault lymphoma (PCVL). A case of PCVL that invaded from subcutaneous tissue into the brain, passing through the skull, and occurred after mild head trauma is reported along with a review of the literature. The patient was a 75-year-old man with decreased activity. One month before his visit to our hospital, he bruised the left frontal area of his head. Magnetic resonance imaging showed homogeneously enhanced tumors with contrast media in the subcutaneous tissue corresponding to the head impact area and the cerebral parenchyma, but no obvious abnormal findings in the skull. A biopsy with craniotomy was performed under general anesthesia. The pathological diagnosis was diffuse large B-cell lymphoma. On histological examination, tumor cells grew aggressively under the skin. Tumor cells invaded along the emissary vein into the external table without remarkable bone destruction and extended across the skull through the Haversian canals in the diploe. Tumor cells were found only at the perivascular areas in the dura mater and extended into the brain parenchyma. Considering the history of head trauma and the neuroimaging and histological findings, the PCVL in the present case arose primarily under the skin, passed though the skull and dura mater, and invaded along vessels and reached the brain.

scholarly journals Microglial Function and Regulation during Development, Homeostasis and Alzheimer’s Disease

Cells ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 957
Author(s):  
Brad T. Casali ◽  
Erin G. Reed-Geaghan
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Immune Cells ◽  
Expression Patterns ◽  
Brain Parenchyma ◽  
Primary Role ◽  
And Function ◽  
Inflammatory Milieu ◽  
The Brain ◽  
Homeostatic State

Microglia are the resident immune cells of the brain, deriving from yolk sac progenitors that populate the brain parenchyma during development. During development and homeostasis, microglia play critical roles in synaptogenesis and synaptic plasticity, in addition to their primary role as immune sentinels. In aging and neurodegenerative diseases generally, and Alzheimer’s disease (AD) specifically, microglial function is altered in ways that significantly diverge from their homeostatic state, inducing a more detrimental inflammatory environment. In this review, we discuss the receptors, signaling, regulation and gene expression patterns of microglia that mediate their phenotype and function contributing to the inflammatory milieu of the AD brain, as well as strategies that target microglia to ameliorate the onset, progression and symptoms of AD.

scholarly journals CTNI-03. IMAGING FEATURES OF LEPTOMENINGEAL METASTASES OF NON-SMALL CELL LUNG CANCER: A SINGLE-CENTER REAL-WORLD STUDY

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii41-ii41
Author(s):  
Junjie Zhen ◽  
Lei Wen ◽  
Shaoqun Li ◽  
Mingyao Lai ◽  
Changguo Shan ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Type A ◽  
Brain Parenchyma ◽  
Imaging Features ◽  
Type B ◽  
Type D ◽  
Mri Examination ◽  
Mri Features ◽  
Brain And Spinal Cord ◽  
The Brain

Abstract BACKGROUND According to EANO-ESMO clinical practice guidelines, the MRI findings of LM are divided into 4 types, namely linear enhancement (type A), nodular enhancement (type B), linear combined with nodular enhancement (type C), and sign of hydrocephalus (type D). METHODS The MRI features of brain and spinal cord in patients diagnosed with NSCLC-LM in Guangdong Sanjiu Brain Hospital from 2010 until 2019 were investigated, and then were classified into 4 types. The imaging features were analyzed. RESULTS A total of 80 patients were enrolled in the study. The median age of the patients was 53.5 years old, and the median time from the initial diagnosis to the confirmed diagnosis of LM was 11.6 months. The results of enhanced MRI examination of the brain in 79 cases showed that the number of cases with enhancements of type A, B, C and D were 50 (63.3%), 0, 26 (32.9%) and 3 (3.8%), respectively, and that LM with metastases to the brain parenchyma was found in 42 cases (53.2%). The results of enhanced MRI examination of spinal cord in 59 cases showed that there were only enhancements of type A and C in 40 cases (67.8%) and 3 cases (5.0%), and no enhancement sign in the other 16 cases (27.2%). CONCLUSION MRI examination of brain and spinal cord will improve the detection rate of LM. The MRI features of NSCLC-LM in real world are mainly characterized by the linear enhancements of brain and spinal cord, followed by linear combined with nodular enhancement. The enhancements of type B and type D are rare in clinic. Almost half of the patients have LM and metastases to the brain parenchyma. Therefore, the differentiation of tumor metastases is needed to be paid attention to for the early diagnosis and the formulation of reasonable treatment plans.

Selective growth of human melanoma cells in the brain parenchyma of nude mice

1996 ◽  
Vol 6 (5) ◽  
pp. 363-371 ◽  
Author(s):  
T Fujimaki ◽  
J E Price ◽  
D Fan ◽  
C D Bucana ◽  
K Itoh ◽  
...  
Keyword(s):  
Nude Mice ◽  
Melanoma Cells ◽  
Brain Parenchyma ◽  
Human Melanoma ◽  
Selective Growth ◽  
Human Melanoma Cells ◽  
The Brain

Effects of endotoxin and dexamethasone on cerebral malaria in mice

Parasitology ◽  
1995 ◽  
Vol 111 (4) ◽  
pp. 443-454 ◽  
Author(s):  
A. L. Neill ◽  
N. H. Hunt
Keyword(s):  
Cerebral Malaria ◽  
Evans Blue ◽  
Plasmodium Berghei ◽  
Tumour Necrosis ◽  
Brain Parenchyma ◽  
Post Inoculation ◽  
Cba Mice ◽  
Cerebral Involvement ◽  
The Brain ◽  
Necrosis Factor

SUMMARYCBA/T6 and DBA/2J mice inoculated withPlasmodium bergheiANKA (PbA) develop cerebral involvement 6–8 days post-inoculation, from which the CBA mice almost invariably die and the DBA mice recover. Dexamethasone (DXM; 80 mg/kg) given to inoculated CBA mice twice, on day 3 and again within 48 h, reduced the cerebral symptoms and prevented death from cerebral malaria. Plasma tumour necrosis factor (TNF) levels, which increased at the time of the cerebral symptoms, were also reduced in these DXM-treated mice. Intravenously administered Evans Blue, a dye which binds to albumin, diffused extensively across the blood-brain barrier only during the period of cerebral symptoms, in proportion to the severity of the cerebral symptoms and the disease. In PbA-infected CBA mice, cerebral symptoms and the amount of Evans Blue diffusing into the brain tissue were both reduced by DXM treatment, but only if the steroid was given on day 3 and again within 48 h. Endotoxin injected intravascularly into PbA-infected DBA mice after day 5 resulted in an exaggeration of cerebral symptoms and death between days 6 and 9. Plasma TNF and the amount of Evans Blue in the brain parenchyma increased above normal levels in these mice. Endotoxin injections had only minor effects on the severity of the cerebral symptoms in PbA-infected CBA mice and did not cause the animals to die sooner.

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