Hemodynamics in Ruptured Intracranial Aneurysms

Incidental detection of unruptured intracranial aneurysms (UIA) has increased in the recent years. There is a need in the clinical community to identify those that are prone to rupture and would require preventive treatment. Hemodynamics in cerebral blood vessels plays a key role in the lifetime cycle of intracranial aneurysms (IA). Understanding their initiation, growth, and rupture or stabilization may identify those hemodynamic features that lead to aneurysm instability and rupture. Modeling hemodynamics using computational fluid dynamics (CFD) could aid in understanding the processes in the development of IA. The neurosurgical approach during operation of IA allows direct visualization of the aneurysm sac and its sampling in many cases. Detailed analysis of the quality of the aneurysm wall under the microscope, together with histological assessment of the aneurysm wall and CFD modeling, can help in building complex knowledge on the relationship between the biology of the wall and hemodynamics. Detailed CFD analysis of the rupture point can further strengthen the association between hemodynamics and rupture. In this chapter we summarize current knowledge on CFD and intracranial aneurysms

Predictive value of clinical, imaging and cerebrospinal fluid dynamics examinations in the diagnostic algorithm of the normal pressure hydrocephalus.

7.SOUHRN Vyhodnocením efektu léčby pacientů s idiopatickým normotenzním hydrocefalem (iNPH) indikovaných k operaci na základě pozitivních suplementárních testů jsme stanovili jejich pozitivní prediktivní hodnotu. Lumbální infuzní test i tap test mají vysokou pozitivní prediktivní hodnotu klinické odpovědi na implantaci shuntu. Pacient s typickou symptomatologií, nálezem hydrocefalu na zobrazovacím vyšetření a pozitivním suplementárním testem bude velmi pravděpodobně z léčby profitovat. Suplementámí testy jsou platnou součástí diagnostického algoritmu i přes svou invazivitu. Pomocí zobrazení difuzních tenzorů na MR mozku provedené u pacientů s iNPH před operací, rok po operaci a u zdravých kontrol jsme zjistili změny difuzních parametrů v periventrikulární bílé hmotě. Pacienti měli ve srovnání se zdravými kontrolami vyšší MD v ALIC, PLIC a CC, což odráží vyšší stupeň periventrikulární axonální degenerace u pacientů s iNPH. Pacienti měli ve srovnání s kontrolami vyšší FA jen v PLIC. Tato oblast je tedy u pacientů s iNPH postižena kompresí. Po implantaci shuntu jsme v PLIC zaznamenali signifikantní pokles FA, což odpovídá dekompresi po derivaci likvoru. Pokles hodnoty však nebyl až k hodnotě zdravých kontrol. U pacientů s iNPH a u zdravých kontrol jsme hodnotili výskyt znaků hydrocefalu s disproporcionálně...8.SUMMARY By evaluating the effect of treatment of patients with idiopathic normal pressure hydrocephalus (iNPH) indicated for surgery based on positive supplementary tests, we determined their positive predictive value. Both the lumbar infusion test and the tap test have a high positive predictive value for the clinical response to shunt surgery. A patient with a typical symptomatology, a radiological examination finding, and a positive supplementary test will most likely benefit from surgery. Supplementary tests are a valid part of the diagnostic algorithm regardless their invasiveness. Using diffusion tensor imaging on the MRI performed in patients with iNPH prior to surgery, one year after surgery and in healthy controls, we found changes in diffusion parameters in the periventricular white matter. Patients had a higher MD in ALIC, PLIC and CC compared to healthy controls, reflecting a higher degree of axonal degeneration in patients with iNPH. Patients in comparison with healthy controls had higher FA only in a PLIC. This area is affected by compression in patients with iNPH more severe. After the shunt surgery, we recorded a significant decrease in PLIC, which corresponds to the decompression after derivation of the CSF. However, the drop in value was not to the value of healthy controls. In patients...Units out of CUMimofakultní pracoviště2. lékařská fakultaSecond Faculty of Medicin

Predictive value of clinical, imaging and cerebrospinal fluid dynamics examinations in the diagnostic algorithm of the normal pressure hydrocephalus.

8.SUMMARY By evaluating the effect of treatment of patients with idiopathic normal pressure hydrocephalus (iNPH) indicated for surgery based on positive supplementary tests, we determined their positive predictive value. Both the lumbar infusion test and the tap test have a high positive predictive value for the clinical response to shunt surgery. A patient with a typical symptomatology, a radiological examination finding, and a positive supplementary test will most likely benefit from surgery. Supplementary tests are a valid part of the diagnostic algorithm regardless their invasiveness. Using diffusion tensor imaging on the MRI performed in patients with iNPH prior to surgery, one year after surgery and in healthy controls, we found changes in diffusion parameters in the periventricular white matter. Patients had a higher MD in ALIC, PLIC and CC compared to healthy controls, reflecting a higher degree of axonal degeneration in patients with iNPH. Patients in comparison with healthy controls had higher FA only in a PLIC. This area is affected by compression in patients with iNPH more severe. After the shunt surgery, we recorded a significant decrease in PLIC, which corresponds to the decompression after derivation of the CSF. However, the drop in value was not to the value of healthy controls. In patients..

Development of the Cerebrospinal Fluid in Early Stage after Hemorrhage in the Central Nervous System

Extravasation of blood in the central nervous system (CNS) represents a very strong damaged associated molecular patterns (DAMP) which is followed by rapid inflammation and can participate in worse outcome of patients. We analyzed cerebrospinal fluid (CSF) from 139 patients after the CNS hemorrhage. We compared 109 survivors (Glasgow Outcome Score (GOS) 5-3) and 30 patients with poor outcomes (GOS 2-1). Statistical evaluations were performed using the Wilcoxon signed-rank test and the Mann–Whitney U test. Almost the same numbers of erythrocytes in both subgroups appeared in days 0–3 (p = 0.927) and a significant increase in patients with GOS 2-1 in days 7–10 after the hemorrhage (p = 0.004) revealed persistence of extravascular blood in the CNS as an adverse factor. We assess 43.3% of patients with GOS 2-1 and only 27.5% of patients with GOS 5-3 with low values of the coefficient of energy balance (KEB < 15.0) in days 0–3 after the hemorrhage as a trend to immediate intensive inflammation in the CNS of patients with poor outcomes. We consider significantly higher concentration of total protein of patients with GOS 2-1 in days 0–3 after hemorrhage (p = 0.008) as the evidence of immediate simultaneously manifested intensive inflammation, swelling of the brain and elevation of intracranial pressure

Can Aspartate Aminotransferase in the Cerebrospinal Fluid Be a Reliable Predictive Parameter?

Brain ischemia after central nervous system (CNS) bleeding significantly influences the final outcome of patients. Catalytic activities of aspartate aminotransferase (AST) in the cerebrospinal fluid (CSF) to detect brain ischemia were determined in this study. The principal aim of our study was to compare the dynamics of AST in 1956 CSF samples collected from 215 patients within a 3-week period after CNS hemorrhage. We compared concentrations of the AST catalytic activities in the CSF of two patient groups: survivors (Glasgow Outcome Score (GOS) 5–3) and patients in a vegetative state or dead (GOS 2–1). All statistical evaluations were performed using mixed models and the F-test adjusted by Kenward and Roger and the Bonferroni adjustment for multiple tests. The significantly higher catalytic activities of AST in the CSF from patients with the GOS of 2–1 when compared to those who survived (GOS 5–3, p = 0.001) were found immediately after CNS haemorrhage. In the further course of time, the difference even increased (p < 0.001). This study confirmed the key association between early signs of brain damage evidenced as an elevated AST activity and the prediction of the final patient’s clinical outcome. The study showed that the level of AST in the CSF could be the relevant diagnostic biomarker of the presence and intensity of brain tissue damage