Background and Purpose: Elevated intracranial pressure (ICP) as a result of intracerebral hemorrhage (ICH) and perihematomal edema often leads to tissue shift, which can be identified in cross-sectional imaging and presents a known predictor of functional outcome. Pulsatility indices (PIs) of the intracranial arteries as measured by transcranial Doppler sonography (TCD) may serve as surrogate parameters for ICP. This study aims to investigate whether PI correlates with ICP and midline shift and serves as a reliable predictor of functional outcome in patients with ICH. Methods: Within a 1-year period between April 2009 and April 2010, 136 patients with acute spontaneous, supratentorial ICH were admitted to our tertiary care hospital. One-hundred and twenty-four patients fulfilled the inclusion criteria and were eligible for analysis. TCD and transcranial duplex sonography were performed on admission and at least once more during hospital stay. Functional outcome was assessed 6 months after discharge. Correlation analyses, logistic regression analyses and receiver operating characteristic curves were calculated. Results: One-hundred and twenty-four patients were included in the analysis. Six-month mortality amounted to 39.5%. The ICH score and PIs of the middle cerebral artery were independent predictors of outcome 6 months after discharge. Conclusions: Early PI monitoring by TCD correlated with ICP and may be used to predict the outcome after 6 months

Dörfler, Arnd

Huttner, Hagen B.

Kiphuth, Ines C.

Köhrmann, Martin

Schwab, Stefan

OPUS FAU - Online-Publikationssystem der Friedrich-Alexander-Universität Erlangen-Nürnberg

Doppler Pulsatility Index in Spontaneous Intracerebral Hemorrhage

Howse, Robert

<intR>²Dok

Residual Anxieties – A Reply to RalfMichaelsRobert Howse 2014-02-20T16:50:42Ralf Michaels describes me as having "taken offense" to his claim about  eternalsupremacy of Germany in doctrinal scholarship. I wish immediately to clarify thatI was not offended at all by his claim; I merely found it to be highly implausible,and rooted in a kind of historical or cultural determinism that is, to say the least,questionable.  Now, however, Michaels in his response considerably revises hisassertion, and says he rejects cultural determinism. The key proposition instead isthat the average German legal scholar is likely to be a better doctrinalist than theaverage American scholar, and conversely the average American scholar is likelyto be better at interdisciplinary, non-doctrinal scholarship than her average Germancounterpart. This is a different claim, and it seems to be about the present, andnot a statement about what must or will be true always. I’m not sure how it couldbe verified – or indeed refuted. But at least as long as a scholar does not think ofherself as "average" it allows that it may be entirely legitimate for her not to limit herambition in legal scholarship to some stereotypical conception of what the folk-mind is supposedly good at.But then Michaels goes on to make the normative claim that "we" should play to ourstrengths, both Americans and Germans. Here though "strengths" seems just tomean what the average scholar today in each country is supposedly better at. That,however, seems an odd benchmark to determine scholarly aspiration: shouldn’t onebe aiming for excellent rather than average? In a way, Michaels' position seemslike a misapplication of the theory of comparative advantage in trade developed byDavid Ricardo: Portugal should be producing wine and England cloth. But does thisreally work for doctrinal and interdisciplinary scholarship? Ricardo assumed that, ata given price consumers from each country would be indifferent as to where theybuy the one commodity or the other. German doctrinal scholarship is not exactly acommodity like wine or cloth. It is not as if Americans are going to buy their doctrinalscholarship from Germany (it is about another legal system and mostly in German,obviously international law being an exception); on the other hand, some forms ofinterdisciplinary scholarship from the US may well be exportable to Germany.Further, why not move "the constraints of cultural and institutional traditions" ratherthan simply bow to them as barriers? Anyone familiar with the intellectual history ofGermany will see how its scientific culture has changed sometimes even in radicaland destabilizing ways in certain periods. Is this the residual anxiety that is leadingMichaels to suggest to Germans that they live with rather than fight against thepostwar "cultural and institutional traditions"? I somehow feel that what is reallybehind Michaels' conservativism or Burkean caution is not yet on the table in thisdebate.- 1 -- 2 -

Residual Anxieties – A Reply to Ralf Michaels

&lt;b&gt;&lt;i&gt;Background and Purpose:&lt;/i&gt;&lt;/b&gt; Elevated intracranial pressure (ICP) as a result of intracerebral hemorrhage (ICH) and perihematomal edema often leads to tissue shift, which can be identified in cross-sectional imaging and presents a known predictor of functional outcome. Pulsatility indices (PIs) of the intracranial arteries as measured by transcranial Doppler sonography (TCD) may serve as surrogate parameters for ICP. This study aims to investigate whether PI correlates with ICP and midline shift and serves as a reliable predictor of functional outcome in patients with ICH. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; Within a 1-year period between April 2009 and April 2010, 136 patients with acute spontaneous, supratentorial ICH were admitted to our tertiary care hospital. One-hundred and twenty-four patients fulfilled the inclusion criteria and were eligible for analysis. TCD and transcranial duplex sonography were performed on admission and at least once more during hospital stay. Functional outcome was assessed 6 months after discharge. Correlation analyses, logistic regression analyses and receiver operating characteristic curves were calculated. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; One-hundred&lt;b&gt; &lt;/b&gt;and twenty-four patients were included in the analysis. Six-month mortality amounted to 39.5%. The ICH score and PIs of the middle cerebral artery were independent predictors of outcome 6 months after discharge. &lt;b&gt;&lt;i&gt;Conclusions:&lt;/i&gt;&lt;/b&gt; Early PI monitoring by TCD correlated with ICP and may be used to predict the outcome after 6 months.</jats:p

Ines C. Kiphuth

Hagen B. Huttner

Arnd Dörfler

Stefan Schwab

Martin Köhrmann

Crossref

European Neurology

Kiphuth, Ines C.

Huttner, Hagen B.

Dörfler, Arnd

Schwab, Stefan

Köhrmann, Martin

OPEN FAU Online-Publikationssystem der Friedrich-Alexander-Universität Erlangen-Nürnberg

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Residual Anxieties – A Reply to Ralf Michaels

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OPEN FAU Online-Publikationssystem der Friedrich-Alexander-Universität Erlangen-Nürnberg