By Anish Bhardwaj, Jeffrey R. Kirsch
The medical administration of sufferers with acute mind and spinal wire harm has developed considerably with the appearance of latest diagnostic and healing modalities. Editors Bhardwaj and Kirsch give you administration of Acute mind and Spinal twine damage, a brand new stand-alone connection with aid latest neurologists and neurosurgeons maintain abreast of the entire fresh developments in mind and spinal wire harm. Divided into 5 sections, mind harm, ischemic stroke, intracerebral and subarachnoid hemorrhage, irritating harm and scientific administration of spinal wire accidents, this article provide you with a precis of the most up-tp-date clinical technology for the scientific administration of sufferers with acute mind and spinal wire accidents.
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Additional info for Acute Brain and Spinal Cord Injury: Evolving Paradigms and Management (Neurological Disease and Therapy)
While this management principle is well supported, the particular threshold at which treatment is initiated varies. Incrementally worse outcomes were documented with increasing duration of ICP readings above 20 mmHg. In addition, worse outcomes were reported in patients with sustained ICP readings of greater than 25 mmHg (81). More recently, another group found that initial or sustained ICP readings of greater than 20 mmHg were effective predictors of poor neurologic outcome among patients with severe head injury (59,81).
14) will continue to provide definitive answers as to what physiologic alterations occur as a result of DC. The results of these much-needed trials are eagerly awaited in the neurocritical care community and may clarify decades of speculation on the effectiveness, or lack thereof, of delayed DC in the management of patients with Decompressive Hemicraniectomy 13 severe TBI. As many neurosurgeons would claim, DC seems to ‘‘make sense;’’ in expanding the physical space to be occupied by edematous brain corralled by the skull’s resistive forces, we imagine DC to be a logical maneuver when less invasive means to control brain pressure fail.
INTRACRANIAL HYPERTENSION Pathophysiology Along with avoidance of cerebral ischemia, the other pillar of modern management is attention to intracranial hypertension, a common complication of severe head injury. Nearly 50% of head-injured patients with intracranial mass lesions and 33% of patients with diffuse axonal injury have persistently elevated ICP (57,58). Many studies have confirmed high mortality rates (*70%) for patients with ICP values greater than 25 mmHg (59). ICP is determined by the contents of the intracranial vault, which is codified by the Monro–Kellie doctrine.