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61. Exposure of cyclosporin a in whole blood, cerebral spinal fluid, and brain extracellular fluid dialysate in adults with traumatic brain injury. Full Text available with Trip Pro

Exposure of cyclosporin a in whole blood, cerebral spinal fluid, and brain extracellular fluid dialysate in adults with traumatic brain injury. Cyclosporin A (CsA), an immunosuppressive medication traditionally used in the prevention of post-transplant rejection, is a promising neuroprotective agent for traumatic brain injury (TBI). Preliminary studies in animals and humans describe the efficacy and safety of CsA when administered following neurotrauma. The objective of this study (...) is to describe CsA exposure in adults with severe TBI by assessing concentrations in whole blood, cerebrospinal fluid (CSF), and brain extracellular fluid (ECF) dialysate as measured by brain microdialysis. Severe TBI patients were enrolled in a randomized controlled trial following the written informed consent of their legal guardians. Patients received either CsA 5 mg/kg as a continuous infusion over 24 h, or matching placebo. Noncompartmental exposure analyses were performed using CsA concentrations

2013 Journal of neurotrauma Controlled trial quality: uncertain

62. SecurAcath for securing cerebrospinal fluid catheters

hydrocephalus a lumbar puncture is done. This is where a sample of CSF is taken from the lower part of the spine and the pressure of the CSF sample is then checked. Removing some CSF in this way may also help improve symptoms. A spinal or lumbar drain may be done if a puncture does not improve the symptoms of hydrocephalus. This is carried out over a few days to see whether symptoms improve. The procedure is usually done using a local anaesthetic. Longer-term treatments for hydrocephalus are shunt surgery (...) without detaching the catheter, which may allow for easier cleaning compared with adhesive securement devices. Current NHS pathway CSF drainage is done to treat hydrocephalus. Congenital and acquired hydrocephalus need prompt treatment to reduce pressure on the brain and avoid brain damage. SecurAcath for securing cerebrospinal fluid catheters (MIB107) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 8T o diagnose

2017 National Institute for Health and Clinical Excellence - Advice

63. Dinosaur Tail Sign: A Useful Spinal MRI Finding Indicative of Cerebrospinal Fluid Leakage. (Abstract)

Dinosaur Tail Sign: A Useful Spinal MRI Finding Indicative of Cerebrospinal Fluid Leakage. To evaluate the imaging characteristics and diagnostic utility of the "Dinosaur tail sign" in the diagnosis of cerebrospinal fluid (CSF) leakage.The authors propose the "Dinosaur tail sign," defined as a combination of the dorsal epidural hyperintensities, fat tissue, spinal cord, and cauda equine on lumbosacral sagittal fat-suppressed T2-weighted image (FST2WI), as a sensitive indicator for diagnosing (...) of the spinal epidural veins on MRI, and paraspinal fluid collections (PFC) on MRM, the "Dinosaur tail sign" was found equally in both SIH and ICSFL patients (6 SIH and 19 ICSFL; 83% of all patients with CSF leakage). The "Dinosaur tail sign" showed sufficient diagnostic utility (sensitivity 83%, specificity 94%, accuracy 89%) that was comparable to that of PFC.The "Dinosaur tail sign" is a useful imaging finding suggestive of CSF leakage. Evaluation of subtle interspinous arched hyperintensities on spinal

2017 Headache

64. Therapeutic hypothermia for intacranial hypertension following traumatic brain injury

cerebral perfusion pressure, the fundamental therapeutic goals after TBI. 2 Traumatic brain injury may be caused by a variety of mechanisms. Aetiology of TBI includes traffic accidents, falls, gunshot wounds, sports, combat events and other violence-related Hypothermia for intracranial hypertension: December 2016 2 incidents. 3, 4 TBI ranges in severity from mild to severe, and in addition to short-term impairment, those who sustain TBI often suffer from persistent symptoms. Symptoms may be lifelong (...) Therapeutic hypothermia for intacranial hypertension following traumatic brain injury Health Policy Advisory Committee on Technology Technology Brief Therapeutic hypothermia for intracranial hypertension following traumatic brain injury December 2016 © State of Queensland (Queensland Department of Health) 2016 This work is licensed under a Creative Commons Attribution Non-Commercial No Derivatives 3.0 Australia licence. In essence, you are free to copy and communicate the work in its current

2018 COAG Health Council - Horizon Scanning Technology Briefs

65. Childhood Brain and Spinal Cord Tumors Treatment Overview (PDQ®): Patient Version

brain tumors are likely to grow quickly and spread into other brain tissue. When a tumor grows into or presses on an area of the brain, it may stop that part of the brain from working the way it should. Both benign and malignant brain tumors can cause or and need treatment. Together, the brain and spinal cord make up the (CNS). The brain controls many important body functions. The brain has three major parts: The is the largest part of the brain. It is at the top of the head. The cerebrum controls (...) part of the brain) contains the cerebrum, lateral ventricle and third ventricle (with cerebrospinal fluid shown in blue), choroid plexus, pineal gland, hypothalamus, pituitary gland, and optic nerve. The posterior fossa/infratentorial area (the lower back part of the brain) contains the cerebellum, tectum, fourth ventricle, and brain stem (midbrain, pons, and medulla). The tentorium separates the supratentorium from the infratentorium (right panel). The skull and meninges protect the brain

2016 PDQ - NCI's Comprehensive Cancer Database

66. Clinical Practice Guideline: Maintenance Intravenous Fluids in Children

of their larger brain/skull size ratio. Symptoms of hyponatremia can be nonspecific, including fussiness, headache, nausea, vomiting, confusion, lethargy, and muscle cramps, making prompt diagnosis difficult. After reports of severe hyponatremia and associated neurologic injury were reported in 1992, a significant debate emerged regarding the appropriateness of administering hypotonic maintenance IVFs to children. In 2003, it was recommended that isotonic fluids be administered to children who are acutely ill (...) . Neurosurgical patients and those with traumatic brain injury were excluded from most studies. Oncology patients have been included in some of the randomized trials, but no specific subanalysis for them has been completed, and data are not available separately to conduct one. Many patients receiving chemotherapy receive high volumes of fluids to prevent renal injury, and there are reports of clinically significant hyponatremia, which is possibly associated with the fluid type. Further study is needed

2019 American Academy of Pediatrics

67. Abdominal girth and dorso-sacral distance can be used to estimate lumbosacral cerebral fluid volume. (Abstract)

Abdominal girth and dorso-sacral distance can be used to estimate lumbosacral cerebral fluid volume. Patients' abdominal girth and vertebral column length are highly correlated with the spread of local anaesthetics after spinal anaesthesia. Lumbosacral cerebrospinal fluid volume is the primary determinant for spinal spread. Thus, we attempted to verify the hypothesis that abdominal girth and dorso-sacral distance are correlated with lumbosacral cerebrospinal fluid volume.Forty-five healthy (...) volunteers were enrolled in this study to measure lumbosacral cerebrospinal fluid volume using magnetic resonance imaging. The age, height, weight, abdominal girth, dorso-sacral distance and lumbosacral cerebrospinal fluid volume of the volunteers were recorded. Multiple linear regression analysis was used to analyse the correlation between age, height, weight, abdominal girth, dorso-sacral distance and lumbosacral cerebrospinal fluid volume.Two volunteers were excluded because of lumbar disc herniation

2017 Acta Anaesthesiologica Scandinavica

68. Quantification of Plasmodium falciparum Histidine-Rich Protein-2 in Cerebral Spinal Fluid from Cerebral Malaria Patients. Full Text available with Trip Pro

Quantification of Plasmodium falciparum Histidine-Rich Protein-2 in Cerebral Spinal Fluid from Cerebral Malaria Patients. A cerebrospinal fluid (CSF) biomarker for cerebral malaria (CM) has not been validated. We examined the detection, semiquantification, and clinical use of the Plasmodium falciparum histidine-rich protein-2 (PfHRP-2) as a parasite antigen biomarker for CM. The PfHRP-2 was detected in archival CSF samples from CM patients from Tanzania both by a newly developed sensitive (...) and specific immuno-polymerase chain reaction (72 of 73) and by rapid diagnostic tests (62 of 73). The geometric mean PfHRP-2 CSF concentration was 8.76 ng/mL with no differences in those who survived (9.2 ng/mL), those who died (11.1 ng/mL), and those with neurologic sequelae (10.8 ng/mL). All aparasitemic endemic and nonendemic control samples had undetectable CSF PfHRP-2. In a separate group of 11 matched plasma and CSF cerebral malaria patient samples, the ratio of plasma to CSF PfHRP-2 was 175

2014 American Journal of Tropical Medicine & Hygiene

69. Hydranencephaly: cerebral spinal fluid instead of cerebral mantles Full Text available with Trip Pro

Hydranencephaly: cerebral spinal fluid instead of cerebral mantles The authors report a wide and updated revision of hydranencephaly, including a literature review, and present the case of a patient affected by this condition, still alive at 36 months.Hydranencephaly is an isolated and with a severe prognosis abnormality, affecting the cerebral mantle. In this condition, the cerebral hemispheres are completely or almost completely absent and are replaced by a membranous sac filled (...) with cerebrospinal fluid. Midbrain is usually not involved. Hydranencephaly is a relatively rare cerebral disorder. Differential diagnosis is mainly relevant when considering severe hydrocephalus, poroencephalic cyst and alobar holoprosencephaly. Ethical questions related to the correct criteria for the surgical treatment are also discussed.

2014 Italian journal of pediatrics

70. Defining Optimal Brain Health in Adults Full Text available with Trip Pro

and dementia are common in the population, especially among older people, and exact a substantial economic and personal toll. As the population in the United States ages, cardiovascular risk factors such as obesity, hypertension, and diabetes mellitus are expected to continue to significantly increase in frequency. Subclinical vascular brain injury (eg, brain white matter hyperintensities, microinfarcts, cerebral microbleeds) and symptomatic stroke, antecedent risks, and associated factors are frequently (...) and Milieu Optimal brain function depends on many energy-intensive activities ranging from synaptic activity and subsequent restoration of resting ionic gradients and chemical milieu to protein synthesis and axonal transport. With minimal or no energy reserves and the exquisite sensitivity of neurons and glia to chemical changes in the internal milieu, normal brain function is highly dependent on adequate delivery of energy substrates, mainly oxygen and glucose. These are delivered by cerebral blood flow

2017 American Heart Association

71. Management of Brain Arteriovenous Malformations: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Full Text available with Trip Pro

with ruptured and unruptured brain arteriovenous malformations, suggestions for management, and implications for future research. Brain arteriovenous malformations (bAVMs) are uncommon vascular lesions that present with spontaneous intracranial hemorrhage (ICH), seizures, or headache and typically in young adults. A large proportion of patients are diagnosed with incidental asymptomatic bAVMs after brain imaging is obtained for other reasons. Current treatment options include conservative management (...) obstruction, and deep or infratentorial location. Identification of these features is critically important and guides treatment in many patients. Genetic factors and microscopic hemorrhage have also been associated with hemorrhage as a clinical presentation. Figure 1. Artist’s rendition of a superficial brain arteriovenous malformation on the cortical surface. The primary feeding arteries are branches of the middle cerebral artery. There is a small feeding artery aneurysm seen best on the magnified inset

2017 American Heart Association

72. Management of brain arteriovenous malformations

that present with spontaneous intracranial hemorrhage (ICH), seizures, or headache and typically in young adults. A large proportion of patients are diagnosed with incidental asymptomatic bAVMs after brain imaging is obtained for other reasons. Current treatment options include conservative management, surgical resection, stereotactic radiosurgery (SRS), endovascular embolization, or combinations of these treatments (multimodal therapy). The primary goal of these interventions is to prevent hemorrhagic (...) associated with hemorrhage as a clinical presentation. Figure 1. Artist’s rendition of a superficial brain arteriovenous malformation on the cortical surface. The primary feeding arteries are branches of the middle cerebral artery. There is a small feeding artery aneurysm seen best on the magnified inset in the top left corner. The nidus is depicted as a mix of red and blue vessels. The draining veins are superficial (on the cortical surface and draining to the sagittal and transverse sinuses). Figure 2

2017 American Academy of Neurology

73. Clinical Practice Guideline for the Management of Communication and Swallowing Disorders following Paediatric Traumatic Brain Injury

data is limited to guide speech, language and swallowing disorders. The following variables may be considered by speech-language pathologists and medical specialists when determining prognosis: • Extent and severity of brain damage (including size and site of lesion(s)) and other proxy measures e.g., Glasgow Coma Scale score, length of ventilation and intubation, loss of consciousness and length of post traumatic amnesia, brain surgery required post-injury, raised intracranial pressure • Cause (...) Clinical Practice Guideline for the Management of Communication and Swallowing Disorders following Paediatric Traumatic Brain Injury CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF COMMUNICATION AND SWALLOWING DISORDERS FOLLOWING PAEDIATRIC TRAUMATIC BRAIN INJURY GUIDELINE© Murdoch Childrens Research Institute and the National Health and Medical Research Council Centre of Research Excellence on Psychosocial Rehabilitation in Traumatic Brain Injury 2017 Publisher: Murdoch Childrens Research

2017 Clinical Practice Guidelines Portal

74. A case report of intracranial hemorrhage after spinal anesthesia Full Text available with Trip Pro

A case report of intracranial hemorrhage after spinal anesthesia Chronic subdural hematoma (CSDH) after spinal anesthesia is a rare complication. We experienced a patient who developed CSDH after postdural puncture headache (PDPH) following combined spinal and epidural anesthesia (CSE).A 38-week-gestation parturient with a history of previous cesarean delivery underwent elective cesarean section under CSE. She had been receiving aspirin therapy for Kawasaki disease for many years. She developed (...) a symptom of PDPH 1 day after the surgery. Fluid administration and analgesics were started. Although the headache was relatively severe and persistent, it suddenly disappeared on the third postoperative day. Aspirin administration was restarted on the third postoperative day, and the patient was discharged 1 week after the surgery. 2 weeks after being discharged, she was readmitted to our hospital for severe headache and was diagnosed as having CSDH. An epidural blood patch was performed, resulting

2017 Ja Clinical Reports

75. Imaging Features of the Brain, Cerebral Vessels and Spine in Pediatric Tuberculous Meningitis with Associated Hydrocephalus. Full Text available with Trip Pro

the difficulty of lumbar puncture and correlated with high cerebrospinal fluid protein content.TBM involves extensive pathology in the central nervous system. Severe infarction was predictive of poor outcome although this was not the case for angiographic abnormalities. Spinal disease occurs commonly and has important implications for diagnosis and treatment. Comprehensive imaging of the brain, spine and cerebral vessels adds insight into disease pathophysiology. (...) Imaging Features of the Brain, Cerebral Vessels and Spine in Pediatric Tuberculous Meningitis with Associated Hydrocephalus. Pediatric tuberculous meningitis (TBM) leads to high rates of mortality and morbidity. Prompt diagnosis and initiation of treatment are challenging; imaging findings play a key role in establishing the presumptive diagnosis. General brain imaging findings are well reported; however, specific data on cerebral vascular and spinal involvement in children are sparse.This

2016 Pediatric Infectious Dsease Journal

76. A systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression

risk of SCC. In one study, risk of SCC before death was 24%, and 2.37 times greater with a Gleason score = 7 than with a score of 90% of patients, spinal metastases are extradural, most often arising in the vertebral column and then extending into the epidural space. Spinal metastases very rarely involve the intradural and intramedullary regions of the spine. 10 The average time from original diagnosis of cancer to development of spinal metastases has been estimated to be 32 months and the average (...) A systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression http://wrap.warwick.ac.uk/ Original citation: Sutcliffe, Paul A., Connock, M., Shyangdan, Deepson S., Court, Rachel A., Kandala, Ngianga-Bakwin and Clarke, Aileen, 1955-. (2013) A systematic review of evidence on malignant spinal metastases : natural history and technologies for identifying patients at high risk

2013 NIHR HTA programme

77. Nusinersen sodium (Spinraza) - Spinal Muscular Atrophy

. Hippocampal vacuolation was absent in brain sections processed using alternative fixation methods. The incidence and severity of these fixation-induced vacuoles was greatest in the 14-week monkey IT study which had the most intensive dosing schedule (45 mg total dose in 14 weeks) and achieved the highest concentrations in lumbar spine and cerebral cortex (169 and 166 µg/g, respectively). Per the applicant, further support for the lack of significance of the hippocampal vacuoles was provided (...) to function. This interpretation, based on the microscopic severity, was supported by the lack of effects on neurobehavioral assessments in these animals. The 53-week monkey study was designed to achieve an intermediate level of exposure compared to the 14-week study and determine if there was any progression or additional toxicities seen with chronic exposure. The total dose in the first 3 months of this study was 24 mg, which produced lumbar spinal cord and cerebral cortex concentrations of 106 and 71

2017 European Medicines Agency - EPARs

78. Nusinersen (Spinraza) - for the treatment of 5q spinal muscular atrophy (SMA)

Scottish Medicines Consortium 2 Indication For the treatment of 5q spinal muscular atrophy (SMA). 1 Dosing Information The recommended dosage is 12mg administered by intrathecal injection over one to three minutes. New treatment should be initiated as early as possible after diagnosis with four loading doses on days 0, 14, 28, and 63, followed by maintenance doses administered every four months thereafter. It is recommended that the volume of cerebral spinal fluid, equivalent to the volume (...) of nusinersen to be injected, is removed prior to administration. Treatment with nusinersen should only be initiated by a physician with experience in the management of spinal muscular atrophy (SMA). Treatment should be administered by health care professionals experienced in performing lumbar punctures. Information on long term efficacy is not available. The need for continuation of therapy should be reviewed regularly and considered on an individual basis depending on the patient’s clinical presentation

2018 Scottish Medicines Consortium

79. Monogenic cerebral small-vessel diseases

X X X Encephalopathy X X X Seizures X (rarely) X X Mood disorders X X X X X X Alopecia X X Lumbar spine problems X X Extracerebral features X X X X X X Neuroimaging Lacunar infarcts X X X X X X WMHs X X X X X X X Cerebral microbleeds (no speci?c location) X X X Anterior temporal pole WMH X X X Large contrast-enhanced white matter lesions X Cortical and subcortical signal abnormalities often crossing vascular territories X AD, autosomal dominant; AR, autosomal recessive; CADASIL, cerebral (...) intracerebral haemorrhage of undetermined origin or WMHs of undetermined origin or porencephaly haemorrhage of undetermined origin when there is a family history of cerebral haemorrhage, porencephaly, retinal vessel tortuosities, haematuria, glomerular dysfunction, renal insu?ciency, renal cysts, infantile hemiparesis, early cataracts, abnormalities of the anterior segment of eyes, multiple intracranial aneurysms, muscle cramps or hepatic cyst is present in at least one ?rst- or second-degree relative 4.78

2020 European Academy of Neurology

80. Idiopathic intracranial hypertension

field testing (perimetry) optic disc photographs MRI of brain with or without contrast lumbar puncture at spinal L3/L4 magnetic resonance venogram of head optical coherence tomography (OCT) Treatment algorithm ACUTE Contributors Authors Professor Department of Neurology and Department of Ophthalmology & Visual Sciences University of Iowa Hospitals & Clinics and Iowa City VA Health Care System Iowa City IA Disclosures MW declares that he has no competing interests. Chief Resident in Ophthalmology (...) Idiopathic intracranial hypertension Idiopathic intracranial hypertension - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Idiopathic intracranial hypertension Last reviewed: February 2019 Last updated: October 2018 Summary The most popular hypothesis is that idiopathic intracranial hypertension (IIH) is a syndrome of reduced cerebrospinal fluid absorption. Clinical features include headaches, pulse-synchronous

2018 BMJ Best Practice

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