Acute Brain and Spinal Cord Injury: Evolving Paradigms and by Anish Bhardwaj, Jeffrey R. Kirsch

By Anish Bhardwaj, Jeffrey R. Kirsch

The scientific administration of sufferers with acute mind and spinal twine damage has advanced considerably with the arrival of latest diagnostic and healing modalities. Editors Bhardwaj and Kirsch provide you with administration of Acute mind and Spinal twine damage, a brand new stand-alone connection with support trendy neurologists and neurosurgeons maintain abreast of the entire fresh developments in mind and spinal wire damage. Divided into 5 sections, mind harm, ischemic stroke, intracerebral and subarachnoid hemorrhage, anxious damage and scientific administration of spinal twine accidents, this article offer you a precis of the most up-tp-date clinical technological know-how for the medical administration of sufferers with acute mind and spinal twine accidents.

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Quantification of renal blood flow with contrast-enhanced ultrasound. J Am Coll Cardiol 2001; 37(4):1135–1140. 14 Dunn and Ellegala 14. Heppner P, Ellegala DB, Durieux M, et al. Contrast ultrasonographic assessment of cerebral perfusion in patients undergoing decompressive craniectomy for traumatic brain injury. J Neurosurg 2006; 104(5):738–745. 15. Maas AI, Fleckenstein W, de Jong DA, et al. Monitoring cerebral oxygenation: experimental studies and preliminary clinical results of continuous monitoring of cerebrospinal fluid and brain tissue oxygen tension.

17. Valadka AB, Gopinath SP, Contant CF, et al. Relationship of brain tissue PO2 to outcome after severe head injury. Criti Care Med 1998; 26(9):1576–1581. 18. van Santbrink H, van den Brink WA, Steyerberg EW, et al. Brain tissue oxygen response in severe traumatic brain injury. Acta Neurochir (Wien) 2003; 145(6): 429–438 (discussion 438). 19. van den Brink WA, van Santbrink H, Steyerberg EW, et al. Brain oxygen tension in severe head injury. Neurosurgery 2000; 46(4):868–876 (discussion 876–868).

This increased intravascular blood volume can increase ICP. When CPP is restored, pial arterioles can constrict and ICP will often decrease (67). Monitoring Consensus has emerged regarding indications for placing an ICP monitor in patients with TBI; this is based on the identification of groups at risk for developing intracranial hypertension. At highest risk are patients with GCS scores below 8 and abnormal CT scans; up to 60% of these patients develop elevated ICP readings (68). While patients with GCS scores below 8 with normal-appearing CT scans on admission have a 10% to 15% chance of developing elevated ICPs, a subgroup with a 60% chance of intracranial hypertension does exist: those who Cerebroprotective Strategies 27 present with age over 40 years, systolic blood pressure less than 90 mmHg, and unilateral or bilateral motor posturing (44,68,69).

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