Brain herniation in a patient with apparently normal intracranial pressure: a case report

Introduction Intracranial pressure monitoring is commonly implemented in patients with neurologic injury and at high risk of developing intracranial hypertension, to detect changes in intracranial pressure in a timely manner. This enables early and potentially life-saving treatment of intracranial hypertension. Case presentation An intraparenchymal pressure probe was placed in the hemisphere contralateral to a large basal ganglia hemorrhage in a 75-year-old Caucasian man who was mechanically ventilated and sedated because of depressed consciousness. Intracranial pressures were continuously recorded and never exceeded 17 mmHg. After sedation had been stopped, our patient showed clinical signs of transtentorial brain herniation, despite apparently normal intracranial pressures (less than 10 mmHg). Computed tomography revealed that the size of the intracerebral hematoma had increased together with significant unilateral brain edema and transtentorial herniation. The contralateral hemisphere where the intraparenchymal pressure probe was placed appeared normal. Our patient underwent emergency decompressive craniotomy and was tracheotomized early, but did not completely recover. Conclusions Intraparenchymal pressure probes placed in the hemisphere contralateral to an intracerebral hematoma may dramatically underestimate intracranial pressure despite apparently normal values, even in the case of transtentorial brain herniation

The SpecMAT active target

SpecMAT is a magnetic active target (AT) for transfer reaction studies with low-intensity radioactive ion beams at the ISOLDE facility (CERN). SpecMAT combines two types of detectors: a gas-filled time projection chamber (TPC), the core detector for tracking charged particles emitted in nuclear reactions, and an array of auxiliary scintillation detectors for in-flight γ-ray spectroscopy. All active target components are optimised for operation in a strong background magnetic field. The TPC has a cylindrical shape. Its electron detector is a bulk Micromegas segmented into 2916 triangular pads for sampling charged particle tracks. The scintillation array is composed of 45 detectors with cubic 48 × 48 × 48 mm3 CeBr3 crystals. The General Electronics for TPC (GET) is used in SpecMAT to read out both detector types allowing correlation of the detected γ-rays with the TPC events. This article describes the SpecMAT active target and its characterisation with the α-decay of 241Am. A γ-ray spectrum obtained in correlation with 3D tracks left by charged particles in an active target is reported for the first time for such detectors.SCOPUS: ar.jDecretOANoAutActifinfo:eu-repo/semantics/publishe