Correlation between transcranial Doppler parameters and parenchymal intracranial pressure in an experimental model of cerebral rebleeding

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El síndrome compartimental intracraneal: un modelo propuesto para la monitorización y el tratamiento de la lesión cerebral aguda

Durante décadas, uno de los principales objetivos en el tratamiento de la lesión cerebral aguda (LCA) grave ha sido el control de la hipertensión intracraneal (HIC). Sin embargo, la determinación de la HIC ha sufrido variaciones en sus umbrales a lo largo del tiempo sin que existan pruebas claras de ello. Mientras tanto, los avances en la comprensión de la dinámica del contenido intracraneal (cerebro, sangre y líquido cefalorraquídeo) y el desarrollo reciente de las técnicas de monitorización sugieren que centrarse en la distensibilidad intracraneal (CCI) podría ser un enfoque más fiable que guiar las acciones por valores predeterminados de presión intracraneal. Se sabe que el deterioro de la CCI pronostica la HI, ya que el volumen intracraneal puede aumentar rápidamente dentro del cráneo, una caja ósea cerrada con una expansibilidad irrisoria. Por lo tanto, puede producirse un síndrome compartimental intracraneal (ICCS) con efectos cerebrales deletéreos, precipitando una reducción de la perfusión cerebral, induciendo así una isquemia cerebral. El objetivo de la presente revisión en perspectiva es debatir el concepto de ICCS y sugerir un modelo integrador para la combinación de técnicas modernas invasivas y no invasivas para la evaluación de IH e ICC. La teoría y la lógica sugieren que la combinación de múltiples métodos auxiliares puede mejorar la predicción del deterioro de la ICC, señalando acciones proactivas y mejorando los resultados de los pacientes.For decades, one of the main targets in the management of severe acute brain injury (ABI) has been intracranial hypertension (IH) control. However, the determination of IH has sufered variations in its thresholds over time without clear evidence for it. Meanwhile, progress in the understanding of intracranial content (brain, blood and cerebrospinal fuid) dynamics and recent development in monitoring techniques suggest that targeting intracranial compliance (ICC) could be a more reliable approach rather than guiding actions by predetermined intracranial pressure values. It is known that ICC impairment forecasts IH, as intracranial volume may rapidly increase inside the skull, a closed bony box with derisory expansibility. Therefore, an intracranial compartmental syndrome (ICCS) can occur with deleterious brain efects, precipitating a reduction in brain perfusion, thereby inducing brain ischemia. The present perspective review aims to discuss the ICCS concept and suggest an integrative model for the combination of modern invasive and noninvasive techniques for IH and ICC assessment. The theory and logic suggest that the combination of multiple ancillary methods may enhance ICC impairment prediction, pointing proactive actions and improving patient outcomes

Cortical mapping with navigated transcranial magnetic stimulation in low-grade glioma surgery

Transcranial magnetic stimulation (TMS) is a promising method for both investigation and therapeutic treatment of psychiatric and neurologic disorders and, more recently, for brain mapping. This study describes the application of navigated TMS for motor cortex mapping in patients with a brain tumor located close to the precentral gyrus

Holmes Tremor Secondary to a Stabbing Lesion in the Midbrain

Background: The development of Holmes tremor (HT) after a direct lesion of the midbrain has rarely been reported in the literature, although several etiologies have been linked with HT, such as stroke, brainstem tumors, multiple sclerosis, head trauma, or infections. Phenomenology Shown: A 31-year-old male, having been stabbed in the right eye, presented with a rest and action tremor in the left upper limb associated with left hemiparesis with corresponding post-contrast volumetric magnetic resonance imaging T1 with sagittal oblique reformation showing the knife trajectory reaching the right midbrain. Educational Value: Despite the rarity of the etiology of HT in the present case, clinicians working with persons with brain injuries should be aware of this type of situation

Remote Postoperative Epidural Hematoma after Subdural Hygroma Drainage

Objective. Subdural hygroma is reported to occur in 5%–20% of all patients with closed head trauma, the treatment is controversial and in symptomatic cases surgical drainage is need. We report on a new case with remote acute epidural hematoma (AEH) after subdural hygroma drainage. Case Presentation. A 38-year-old man suffered blunt head trauma and had diffuse axonal injury grade III in CT scan. A CT scan that was late performed showed an increasing subdural fluid collection with mild mass effect and some effacement of the left lateral ventricle. We perform a trepanation with drainage of a hypertensive subdural collection with citrine aspect. Postoperative tomography demonstrated a large left AEH. Craniotomy and evacuation of the hematoma were performed. Conclusion. The mechanism of remote postoperative AEH formation is unclear. Complete reliance on neurologic monitoring, trust in an early CT scan, and a relative complacency after an apparently successful initial surgery for hygroma drainage may delay the diagnosis of this postoperative AEH

Traumatic Pseudoaneurysm of the Middle Meningeal Artery Causing an Intracerebral Hemorrhage

Traumatic aneurysms comprise less than 1% of all intracranial aneurysms. Most of these aneurysms are actually false aneurysms, or pseudoaneurysms, which are caused by the rupture of entire vessel wall layers, with the wall of the aneurysm being formed by the surrounding cerebral structures. Traumatic pseudoaneurysms of the middle meningeal artery are also rare. Only four cases have been reported in the literature with intracerebral hematoma. In this paper, the authors report a case of a patient with a ruptured traumatic pseudoaneurysm of the MMA who presented with an intracerebral hematoma in the left temporal region immediately after trauma; the patient underwent endovascular treatment

Updates and current perspectives of psychiatric assessments after traumatic brain injury: a systematic review

Neuropsychological and psychiatric disorders represent a major concern and cause of disabilities after the trauma, contributing to worse recovery after traumatic brain injury (TBI). However, the lack of well-defined parameters to evaluate patient's psychiatric disorders leads to a wide range of diagnoses and symptoms. The aim of this study was to perform a review of literature in order to gather data of the most common scales and inventories used to assess and diagnose depression, anxiety, and posttraumatic stress disorder (PTSD) after TBI. We conducted a literature search via MEDLINE, PubMed, and Web of Science. We included reviews, systematic reviews, and meta-analysis studies, and we used the following keywords: "traumatic brain injury OR TBI," "depression OR depressive disorder," "anxiety," and "posttraumatic stress disorder OR PTSD." From 610 titles, a total of 68 systematic reviews or meta-analysis were included in the section "Results" of this review: depression (n = 32), anxiety (n = 9), and PTSD (n = 27). Depression after TBI is a more established condition, with more homogeneous studies. Anxiety and PTSD disorders have been studied in a heterogeneous way, usually as comorbidity with other psychiatric disorders. Some scales and inventories designed for the general community may not be appropriate for patients with TBI7CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQ201809/2014-