Posts Tagged ‘head injury’
Ahead of Print: PI for ICP/CPP Assessment
Background: It has been postulated that Gosling’s pulsatility-index (PI) assessed with transcranial Doppler (TCD) has a diagnostic value for non-invasive estimation of intracranial pressure (ICP) and cerebral perfusion pressure (CPP).
Objective: To revisit this hypothesis using a database of digitally stored signals from a cohort of head injured patients.
Methods: We analyzed prospectively collected data of patients admitted to the Cambridge Neuroscience critical care unit who had continuous recordings of ABP, ICP, and cerebral blood flow velocities (FV) using TCD. PI was calculated (Fvsys-Fvdia/Fvmean) over each recording session. Statistical analysis was performed using Spearman’s rank correlation, Receiver-Operator-Characteristics (ROC) methods, and modeling of a non-linear PI-ICP/CPP graph.
Editor Choice: Importance of PbtO2 Probe Location
Background: Monitoring brain tissue PO2 (PbtO2) is part of multimodality monitoring of patients with traumatic brain injury (TBI). However, PbtO2 measurement is a sampling of only a small area of tissue surrounding the sensor tip.
Objective: To examine the effect of catheter location on the relationship between PbtO2and neurological outcome.
Methods: A total of 405 patients who had PbtO2 monitoring as part of standard management of severe traumatic brain injury were studied. The relationships between probe location and resulting PbtO2 and outcome were examined.
In the News: Enduring Symptoms after Multiple Concussions
“Early Indicators of Enduring Symptoms in High School Athletes With Multiple Previous Concussions“ by Schatz et al is referenced in a Grantland.com article titled “The Fragile Teenage Brain,” by Jonah Lehrer.
“The consequences appear to be particularly severe for the adolescent brain. According to a study published last year in Neurosurgery, high school football players who suffered two or more concussions reported mental problems at much higher rates, including headaches, dizziness, and sleeping issues. The scientists describe these symptoms as “neural precursors,” warning signs that something in the head has gone seriously wrong.”
Ahead of Print: Intracranial Pressure and Brain Oxygenation
Background: Intracranial pressure (ICP) monitoring is a cornerstone of care for severe traumatic brain injury (TBI). Management of ICP can help ensure adequate cerebral blood flow and oxygenation. However, studies indicate that brain hypoxia may occur despite ‘normal’ ICP and the relationship between ICP and brain oxygenation is poorly defined. This is particularly important for children in whom less is known about intracranial dynamics.
Objective: To examine the relationship between ICP and brain tissue oxygen (PbtO2) in children with severe TBI (Glasgow Comma Score [GCS]
Methods: The relationship between time-linked hourly and high frequency ICP and PbtO2 data was examined using correlation, regression and generalized estimating equations. Thresholds for ICP were examined against reduced PbtO2 using age bands and receiver-operating curves.
Free Article: Heading in Soccer: Dangerous Play?
Soccer is the world’s most popular sport and unique in that players use their unprotected heads to intentionally deflect, stop, or redirect the ball for both offensive and defensive strategies. Headed balls travel at high velocity pre- and postimpact. Players, coaches, parents, and physicians are justifiably concerned with soccer heading injury risk. Furthermore, risk of long-term neurocognitive and motor deficits caused by repetitively heading a soccer ball remains unknown. We review the theoretical concerns, the results of biomechanical laboratory experiments, and the available clinical data regarding the effects of chronic, subconcussive head injury during heading in soccer.
Free full text access for Neurosurgery subscribers at Neurosurgery-Online.com.
