Interhemispheric supratentorial intracranial pressure gradients in head-injured patients: are they clinically important?

Sahuquillo, Juan; Poca, M.A.; Arribas, Mercedes; Garnacho, Á; Rubio, Enrique

doi:10.3171/jns.1999.90.1.0016

Cited by 128 publications

(69 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…11,13,16,[25][26][27][28][29][30] However, the pathophysiological mechanisms after diffuse brain damage and SAH cannot be compared with the spaceoccupying edema after large focal ischemia, which might affect the value of the monitoring in these patients. 31 So far, no other studies of multimodal monitoring have been conducted in patients with large hemispheric infarction. In space-occupying MCA infarction, sooner or later primarily healthy brain tissue of the contralateral hemisphere becomes involved in the process of expanding edema.…”

Section: Discussionmentioning

confidence: 99%

Multimodal Online Monitoring in Middle Cerebral Artery Territory Stroke

Steiner

Pilz²,

Schellinger³

et al. 2001

Stroke

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Multimodal Online Monitoring in Middle Cerebral Artery Territory Stroke

Steiner

Pilz²,

Schellinger³

et al. 2001

Stroke

View full text Add to dashboard Cite

“…We know that the pressure within the skull is unevenly distributed, with demonstrated intracranial pressure (ICP) gradients [ 4 ]. In pathophysiology and clinical practice, little is known about the ICP profi les in the supratentorial and infratentorial compartments.…”

Section: Introductionmentioning

confidence: 99%

Characterisation of Supra- and Infratentorial ICP Profiles

Moyse

Ros

Marhar

et al. 2016

Acta Neurochirurgica Supplement

View full text Add to dashboard Cite

OATAO is an open access repository that collects the work of Toulouse researchers and makes it freely available over the web where possible. This is an author-deposited version published in: http://oatao.univ-toulouse.fr/ Eprints ID: 18161To link to this article: DOI: 10.1007/978-3-319-22533-3_7 URL: http://dx.doi.org/10.1007/978-3-319-22533-3_7To cite this version: Moyse, Emmanuel and Ros, Maxime and Marhar, Fouad and Swider, Pascal and Schmidt, Eric Albert Characterisation of supra-and infratentorial ICP profiles. (2016) In: Intracranial Pressure and Brain Monitoring XV. (Acta Neurochirurgica Supplement). Springer, Cham, pp. 37-40. ISBN 978-3-319-22532-6 Any correspondence concerning this service should be sent to the repository administrator: staff-oatao@listes-diff.inp-toulouse.fr Abstract In pathophysiology and clinical practice, the intracranial pressure (ICP) profi les in the supratentorial and infratentorial compartments are unclear. We know that the pressure within the skull is unevenly distributed, with demonstrated ICP gradients. We recorded and characterised the supra-and infratentorial ICP patterns to understand what drives the transtentorial ICP gradient.A 70-year-old man was operated on for acute cerebellar infarction. One supratentorial probe and one cerebellar probe were implanted. Both signals were recorded concurrently and analysed off-line. We calculated mean ICP, ICP pulse amplitude, respiratory waves, slow waves and the RAP index of supra-and infratentorial ICP signals. Then, we measured transtentorial difference and performed correlation analysis for every index.Supratentorial ICP mean was 8.5 mmHg lower than infratentorial ICP, but the difference lessens for higher values. Both signals across the tentorium showed close correlation. Supra-and infratentorial pulse amplitude, respiratory waves and slow waves also showed a high degree of correlation. The compensatory reserve (RAP) showed good correlation. In this case report, we demonstrate that the mean value of ICP is higher in the posterior fossa, with a strong correlation across the tentorium. All other ICPderived parameters display a symmetrical profi le.

show abstract

“…47 It is well known that CBF and cerebral autoregulation are heterogeneous after TBI and tend to be reduced in the immediate vicinity of a contusion. 33 This finding can be explained by interhemispheric ICP gradients, 44 local tissue pressure gradients leading to mass shift, and asymmetry of CVR due to a heterogeneous pattern of endothelial dysfunction. There is a surprising but established correlation between the asymmetry of autoregulation and a poor outcome.…”

mentioning

confidence: 99%

“…Patients who died after TBI had a worse and mainly asymmetrical autoregulation. 44 An understanding of the state of cerebral autoregulation permits more individualized critical care of a patient with TBI, as reflected in the most recent guidelines on the management of severe TBI. [7][8][9] In patients with impaired autoregulation, attempts to improve CPP values by using vasopressors can precipitate a dangerous CBF (malignant hyperemia).…”

mentioning

confidence: 99%

Cerebral pressure autoregulation in traumatic brain injury

Rangel-Castilla

Gasco

Nauta

et al. 2008

FOC

183

104

View full text Add to dashboard Cite

An understanding of normal cerebral autoregulation and its response to pathological derangements is helpful in the diagnosis, monitoring, management, and prognosis of severe traumatic brain injury (TBI). Pressure autoregulation is the most common approach in testing the effects of mean arterial blood pressure on cerebral blood flow. A gold standard for measuring cerebral pressure autoregulation is not available, and the literature shows considerable disparity in methods. This fact is not surprising given that cerebral autoregulation is more a concept than a physically measurable entity. Alterations in cerebral autoregulation can vary from patient to patient and over time and are critical during the first 4–5 days after injury. An assessment of cerebral autoregulation as part of bedside neuromonitoring in the neurointensive care unit can allow the individualized treatment of secondary injury in a patient with severe TBI. The assessment of cerebral autoregulation is best achieved with dynamic autoregulation methods. Hyperventilation, hyperoxia, nitric oxide and its derivates, and erythropoietin are some of the therapies that can be helpful in managing cerebral autoregulation. In this review the authors summarize the most important points related to cerebral pressure autoregulation in TBI as applied in clinical practice, based on the literature as well as their own experience.

show abstract

Interhemispheric supratentorial intracranial pressure gradients in head-injured patients: are they clinically important?

Cited by 128 publications

References 41 publications

Multimodal Online Monitoring in Middle Cerebral Artery Territory Stroke

Multimodal Online Monitoring in Middle Cerebral Artery Territory Stroke

Characterisation of Supra- and Infratentorial ICP Profiles

Cerebral pressure autoregulation in traumatic brain injury

Contact Info

Product

Resources

About