Mechanical brain injury: the sympathoadrenal response

Rosner, Michael J.; Newsome, Heber H.; Becker, Donald P.

doi:10.3171/jns.1984.61.1.0076

Cited by 187 publications

(89 citation statements)

References 41 publications

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“…A prevalência da hiperglicemia devido a trauma craniano é considerada alta na literatura publicada 3,6,7 . A fisiopatologia da hiperglicemia não é totalmente compreendida, apesar de várias hipóteses terem sido sugeridas.…”

Section: Discussionunclassified

“…A causa dessa condição é descrita como multifatorial e relacionada ao estresse pós-traumático. A resposta metabólica súbita ao trauma poderia incluir grandes alterações nos níveis de cortisol circulante, glucagon e epinefrina, resultando em alteração no metabolismo da glicose, associada com resistência à insulina, níveis elevados de glicose no sangue e nos tecidos, acidose intracelular, acúmulo de lactato, insuficiência energética, e, consequentemente, lesão neuronal 2,3 . Distinguir a relação causa e efeito entre hiperglicemia e má evolução após TC continua sendo uma tarefa difícil.…”

Section: Discussionunclassified

“…Embora as injúrias relacionadas ao evento traumático sejam a principal causa de morte precoce, condições que se desenvolvem após o trauma, tais como hipóxia, hipotensão, aumento na pressão intracraniana e hiperglicemia, aumentam a mortalidade [1][2][3] . Portanto, a prevenção e o tratamento precoce de patologias que possam ocasionar lesões secundárias são consideradas medidas eficazes para melhorar a evolução dos pacientes.…”

Section: Introductionunclassified

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Admission hyperglycemia is a reliable outcome predictor in children with severe traumatic brain injury

Asilioglu

Turna²,

Paksu³

2011

J Pediatr (Rio J)

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Objective: To identify the relationship between admission hyperglycemia and outcome in children with severe brain injury at hospital discharge and 6 months later.Method: A retrospective analysis of blood glucose levels was conducted in 61 children with severe brain injury admitted to the Pediatric Intensive Care Unit between November 1, 2005 and October 30, 2009. Hyperglycemia was considered for a cut off value of > 150 mg/dL, based on literature. Outcome was measured with the Glasgow Outcome Scale at hospital discharge and 6 months after discharge. Death was also analyzed as an outcome measure. Results:Mean admission blood glucose of the patients was 251 mg/dL (68-791). Hyperglycemia was noted on admission in 51 (83.6%) patients. A moderately significant positive correlation was found between admission blood glucose and severity of head trauma according to Abbreviated Injury Score (r = 0.46). Mean admission glucose level of non-survivors was significantly higher (207 mg/dL vs. 455 mg/dL, p < 0.001). Mean blood glucose level of the patients in bad outcome group was found significantly higher compared to that of the patients in good outcome group at hospital discharge and 6 months after discharge (185 mg/dL vs. 262 mg/dL, p < 0.15 and 184 mg/dL vs. 346 mg/dL, p < 0.04, respectively).Conclusions: Hyperglycemia could be considered as a marker of brain injury and, when present upon admission, could reflect extensive brain damage, frequently associated with mortality and bad outcome. Further studies are needed to investigate the effect of strict glycemic control on mortality and outcomes.J Pediatr (Rio J). 2011;87(4):325-328: Severe head injury, hyperglycemia, outcome, children. ResumoObjetivo: Identificar a relação entre hiperglicemia na admissão e desfecho das crianças com traumatismo cerebral grave na alta hospitalar e 6 meses depois.Método: Análise retrospectiva da glicemia de 61 crianças com traumatismo cerebral grave admitidas na unidade de tratamento intensivo pediátrico entre 1/11/2005 e 30/10/2009. Foi considerado um ponto de corte de > 150 mg/dL para o diagnóstico da hiperglicemia, com base na literatura. A evolução foi avaliada pela escala de resultados de Glasgow na alta hospitalar e 6 meses após a alta. O óbito também foi analisado como uma evolução.Resultados: A glicemia média dos pacientes na admissão foi de 251 mg/dL (68-791). Verificou-se hiperglicemia na admissão em 51 pacientes (83,6%). Encontrou-se uma correlação positiva moderadamente significativa entre glicemia na admissão e gravidade do traumatismo craniano segundo a escala abreviada de injúrias (r = 0,46). A glicemia média dos não sobreviventes foi significativamente maior (207 mg/dL versus 455 mg/dL, p < 0,001). A glicemia média dos pacientes com má evolução foi significativamente maior, comparada à daqueles com boa evolução, na alta hospitalar e 6 meses após a alta (185 mg/dL versus 262 mg/dL, p < 0,15 e 184 mg/dL versus 346 mg/dL, p < 0,04, respectivamente). Conclusões:A hiperglicemia pode ser considerada um marcador de lesão cereb...

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Section: Discussionunclassified

Section: Introductionunclassified

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Admission hyperglycemia is a reliable outcome predictor in children with severe traumatic brain injury

Asilioglu

Turna²,

Paksu³

2011

J Pediatr (Rio J)

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“…Increased permeability of the alveolocapillary membrane secondary to an elevation in catecholamines has been invoked [5]. It was shown that catecholamines dramatically increase after a variety of central nervous system insults [10]. And massive alphaadrenergic stimulation is thought to have an important role in the initial phase of neurogenic pulmonary edema [11].…”

Section: Discussionmentioning

confidence: 99%

De novo Multiple Endocrine Neoplasia Type 2B with Noncardiogenic Pulmonary Edema as the Presenting Symptom

et al. 2006

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Abstract. Multiple endocrine neoplasia (MEN) type 2B is a rare hereditary disorder characterized by medullary thyroid carcinoma, pheochromocytoma, and neuroma. Early signs of MEN 2B are usually neuroma, gastrointestinal problems, and medullary thyroid carcinoma. Noncardiogenic pulmonary edema is rare as a presenting symptom. We report a 31-year-old male who was admitted to our hospital because of noncardiogenic pulmonary edema. He was 168 cm in height, weighed 55 kg, and had an arm span of 166 cm. No marfanoid habitus was evident, but thickened lips and tongue neuroma were present. Chronic constipation had been present since childhood, and the patient had a two-year history of untreated hypertension. Noncardiogenic pulmonary edema and toxic megacolon were noted, and abdominal computed tomography revealed bilateral adrenal tumors. Ultrasonography of the thyroid showed two mass lesions. Intubation and mechanical ventilation were performed because of severe hypoxemia. Endocrinological examinations showed high levels of serum and urinary fractionated catecholamines, serum calcitonin, serum carcinoembryonic antigen, and serum intact parathyroid hormone. It was suggested that the high level of catecholamine from pheochromocytoma had caused the pulmonary edema. RET gene analysis showed a codon 918 mutation in exon 16 resulting in an ATG (methionine) to ACG (threonine) substitution, but analysis of the patient's parents showed the wild type. Therefore, the patient was diagnosed as having de novo MEN 2B. He underwent laparoscopic bilateral adrenectomy and total thyroidectomy. However, the values of serum calcitonin and CEA did not decrease to the normal ranges. Patients with early-stage MEN 2B have distinct characteristics that can aid early detection of the disease, thus possibly allowing them to be saved.

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“…Computed tomography of head was negative for subarachnoid hemorrhage, but angiography revealed a large aneu- tension has been described to be a result of the reflex increase of catecholamine secretion, [6][7][8] and a result of the sympathetic overactivity due to brainstem compression, 9 or due to craniocaudal ischemia. [10][11][12][13] Some animal studies suggest Cushing's response is a late feature, when ICP approaches mean arterial pressure, signalling breakdown of cerebral autoregulation. [14][15][16][17] In this situation, hypertension leads to further increase of ICP, adversely influencing cerebral perfusion.…”

Section: Case Reportmentioning

confidence: 99%

Intraoperative jugular bulb desaturation during acute aneurysmal rupture

Rozet

Newell

Lam

2006

Can J Anesth/J Can Anesth

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Purpose:To describe an episode of acute jugular venous desaturation during intraoperative rupture of a cerebral aneurysm. Clinical features:A 57-yr-old patient was scheduled for clipping of a large unruptured basilar tip aneurysm. Abrupt bulging of the brain was observed after bone flap removal, but before dura was opened. This was associated with concurrent development of systemic hypertension to 200/120 mmHg and jugular venous bulb (S jv O 2 ) desaturation to 13%. Rupture of aneurysm was confirmed by frank blood in cerebrospinal fluid drainage from the lumbar subarachnoid catheter.Conclusions: Abrupt S jv O 2 desaturation prior to dural opening may suggest an acute increase in intracranial pressure, which in our case followed aneurysmal rupture; the systemic response to increased intracranial pressure (Cushing's response) may be ineffective in maintaining cerebral perfusion.

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Mechanical brain injury: the sympathoadrenal response

Cited by 187 publications

References 41 publications

Admission hyperglycemia is a reliable outcome predictor in children with severe traumatic brain injury

Admission hyperglycemia is a reliable outcome predictor in children with severe traumatic brain injury

De novo Multiple Endocrine Neoplasia Type 2B with Noncardiogenic Pulmonary Edema as the Presenting Symptom

Intraoperative jugular bulb desaturation during acute aneurysmal rupture

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