Regional cerebral blood flow and regional metabolism in cold induced oedema.

24 hours following a cold induced oedema in cats rCBF was measured in the lesion area, the bluish stained cortex immediately adjacent to the lesion, a cortical area remote from the lesion, and in the contralateral uninjured hemisphere. Thereafter the brain was frozen and the respective tissue areas were removed and analyzed for water and electrolyte content as well as metabolite concentrations. It seems, that in the neighbourhood of a local lesion at least 3 different brain regions can be differentiated with regard to their characteristic pattern of data. In non-oedematous regions either hyperaemia or hypoaemia could be observed. In areas with local brain oedema rCBF was reduced inversely p…

Energy Metabolism, Lactate/Pyruvate Ratio and Extracellular Space in Cortex and White Matter Adjacent to and Distant from a Local Freezing Lesion

The present investigation was undertaken to study the distribution of pathological fluid accumulation and the local energy metabolism in the cortex and white matter following a localized traumatic lesion of the cortex. A systematic examination of the changes in the tissue following a trauma is the basis for further studies on the relationship between cortical blood supply, local tissue metabolism and local function.

Zusammenfassung der Diskussion zum Thema: „Spezielle anästhesiologische Methoden in der Neurochirurgie“

Measurement of brain tissue pressure in cold induced cerebral oedema.

Experiments were performed in order to evaluate the concept that brain oedema is associated with an increase in local interstitial fluid pressure. Assuming that the pressure measured by the cotton wick technique represents the hydrostatic interstitial fluid pressure, the tissue pressure was recorded with pressure transducers in the white matter adjacent and remote to a local cold injury, in the opposite hemisphere, and in the cisterna magna. In 9 cats during steady-state conditions mean tissue pressures between 1.20±0.30 mm Hg and 2.33±0.80 mm Hg were found, as compared to a mean CSF pressure of 5.17±0.82 mm Hg. The tissue pressure was found to increase significantly adjacent to the lesion …

Double-Blind Study on the Effects of Steroids on Severe Closed Head Injury

The results of a double-blind study on the effects of a low dose and a high dose of dexamethasone on severe closed head injury are presented. The steroid, particularly in high dose, reduced mortality, improved the neurologic course and the final outcome. Timing of steroid administration is of great importance.

Zusammenfassung der Diskussion zum Thema: „Intensivtherapie bei komatösen Patienten“

Zur Messung des intrakraniellen Druckes werden zwei Methoden angegeben, die epidurale und die intraventrikulare. Welche Methode hat die grosere Aussagekraft, welche kann als Routineverfahren empfohlen werden?

Extracellular space and electrolyte distribution in cortex and white matter of dog brain in cold induced oedema

24 hours after a circumscribed cold injury of the cortex dog brains were perfused from the lateral ventricle and the frontal subarachnoidal space to the cisterna magna with an artificial CSF containing trace amounts of35S-labelled thiosulphate. Simultaneously the extracellular tracer was administered intravenously. Extracellular fluid volume was estimated and found to be increased from 10 to 15% in the oedematous cortex and from 10 to 27% in the oedematous white matter. The actual size of ECS in oedematous white matter, however, must be larger as indicated by the relative alterations of thiosulphate distribution, tissue water, sodium and chloride. Apparently a small part of the fluid accumu…

Zusammenfassung der Diskussion zum Thema: „Untersuchungsverfahren bei Bewußtlosen“

Zur Beurteilung empfohlener Untersuchungsverfahren mussen zunachst die Anforderungen, die wir an sie stellen, definiert werden. Es mus klar sein, was die einzelnen Untersuchungsverfahren leisten konnen im Hinblick auf die Einschatzung der Bewustseinslage, auf die Ursache der Bewustseinsstorung und Lokalisation eines zerebralen Prozesses und im Hinblick auf die Prognose der Storung. Schlieslich mus klar werden, wie sich das jeweilige Untersuchungsverfahren in den praktischen Behandlungsplan einfugt, insbesondere auch, welche Bedeutung die Verfahren im Hinblick auf notwendige Sofortmasnahmen haben.

Brain energy metabolism in global brain oedema.

Different degrees of severity in global brain oedema were induced by varying amounts of water intoxication (50, 100, 150, and 200 ml Aqua dest./kg b.wt. intravenously) in groups of six cats, which were functionally nephrectomized. Animals loaded with physiological saline and sham-operated served as controls. Two hours following the water load, the tissue concentrations of CrP, ATP, ADP, AMP, pyruvate, glucose, and lactate were determined by optical enzymatic analysis. The results show disturbances in brain energy metabolism dependent on the severity of the brain oedema. The high energy compounds and in consequence the ATP/ADP-ratio, and respectively the energy charge potential, fall in dire…

The course of intracranial pressure and volume-pressure relationships following extirpation of meningiomas and astrocytomas

Thirty-five patients with meningiomas were compared with 37 patients with astrocytomas with respect to the postoperative course of their ICP and elastance. In the case of the meningioma patients, the ICP increased on average over a longer period and achieved higher values than in the astrocytoma patients. In the first group, the elastance attained values that were three times as high as in the second group. There was no fixed relationship between pressure and elastance in the two groups of patients.

The Role of Monoamines in the Development of Cold-Induced Edema

Our results show that even the experimentally induced high concentrations of exogenous 5-HT in the brain tissue during the early phase of edema formation are not able to increase the amount of fluid accumulation in the normal and injured brain tissue. The changes of the endogenous 5-HT levels in the blood and the brain tissue result in similar hemispheric water and RISA differences between the injured and uninjured half of the brain. Moreover, 5-HT concentrations elevated by 100% failed to produce detectable edema in the normal brain tissue of the rat.

The influence of the decompressive operation on the intracranial pressure and the pressure-volume relation in patients with severe head injuries.

Measurements of intracranial pressure by ventricular catheter were performed in 47 patients with severe head injuries. Thirty-three patients with decompressive operations such as osteoclastic craniotomy and dilatation by means of duraplastic have been compared with 14 patients with closed heads with regard to volume pressure response (intracranial elasticity). This was determined either by intraventricular injection of 2 ml saline or by drainage of cerebrospinal fluid. The examination clearly shows that patients with closed heads have a much higher intracranial elasticity than patients who have decompressive operations, so that in the first group minor differences of the intracranial volume…

Zusammenfassung der Diskussion zum Thema: „Durchführung der Anästhesie bei neurochirurgischen Eingriffen. Fragen zur Prämedikation“

Zusammenfassung der Diskussion zum Thema: „Bewußtseinsstörungen — Ursachen und Pathophysiologie“

Die Beitrage haben gezeigt, das Eingriffe in bestimmte, zum Teil definierbare anatomische Strukturen, wie z. B. die Formatio reticularis des Mittelhirns, aber auch Eingriffe in Grundphanomene elektrophysiologischer und biochemischer Ablaufe, wie sie vielfaltig bei Storungen des zerebralen Sauerstoffverbrauchs, der zerebralen Durchblutung, dem Stoffaustausch an der Blut-Hirn-Schranke, wie auch sekundar bei peripher-metabolischen Entgleisungen vorkommen, zu Storungen der Bewustseinsvorgange fuhren konnen. Nun sind die am Aufbau des Bewustseins beteiligten Vorgange noch nicht im einzelnen bekannt, weshalb auch eine Beschreibung der Stormechanismen schwierig ist. Ein einheitlicher Stormechanism…

The Effect of Dexamethasone and Diuretics on Peritumor Brain Edema: Comparative Study of Tissue Water Content and CT

Eighteen brain tumor patients were pre-operatively treated with dexamethasone, 4 × 4 mg i.m. for 4–6 days, and furosemide, 3 × 40 mg p.o. for 2–4 days. Water and electrolyte content were determined in biopsies removed from peritumoral cortex and white matter during operation and compared with the results from 31 patients not pre-treated and 28 patients treated with dexamethasone alone (16–24 mg i.m./day for 4–6 days). While the water content in cortex did not change significantly it fell in white matter from 79.90 ± 0.81 in untreated to 77.29 ± 0.76 in dexamethasone-treated and to 75.53 ± 1.03 in patients treated with a combination of dexamethasone and furosemide. With the diminution of wat…

Intracranial pressure and pressure volume relation in patients with subarachnoid haemorrhage (SAH)

The development of the intracranial pressure after a subarachnoid haemorrhage was evaluated in 21 patients. A statistically significant relation between the intracranial pressure and the neurological findings was found, whereas vasospasms did not influence the intracranial pressure. In patients in a clinically critical condition, rhythmic pressure waves of a frequency of 1/minute were repeatedly observed.

Giant aneurysm of the vertebral artery causing compression of the lower medulla oblongata

Es wird ein Fall geschildert, bei welchem durch ein Riesenaneurysma am Abgang der Arteria cerebellaris posterior inferior von der linken A. vertebralis zu einer Kompression der Oblongata mit rasch progredienter Tetraparese gefuhrt hatte. An der analogen Stelle an der rechten Vertebralis wurde ein zweites kleineres Aneurysma gefunden.

Dexamethasone in severe head injuries

The results of a double-blind-study on the effects of placebo, a low dose and a high dose of dexamethasone on severe closed head injury are presented. 95 patients were selected and carefully analyzed according to mortality, neurological course and symptoms, midbrain lesions and final outcome. The results demonstrate that dexamethasone, particularly given in high doses, reduces mortality and improves the neurological course. The steroid treatment seems to improve chances as well as quality of survival. Apart from the dose, timing of administration is of great importance.

Zusammenfassung der Diskussion zum Thema: „Physiologie, Pathophysiologie und Pharmakologie“

The Role of Tissue Pressure and Bulk Flow in the Formation and Resolution of Cold-Induced Edema

The mechanisms responsible for the dynamics of cold-induced edema, its spread and resolution, were examined. The findings indicate that bulk flow and not diffusion should be considered as the main mechanism for the edema spreading through the extracellular spaces of the white matter.