A Marmarou

..This article provides an update of our current progress toward supporting this hypothesis and includes an update on the role of aquaporins in traumatic brain edema...

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..A secondary objective was to evaluate prospectively the diagnosis and outcome of surgical treatment in a subset of patients residing in healthcare facilities who were at risk for idiopathic NPH...

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..This report develops evidence-based guidelines for the use of supplementary tests as an aid in prognosis...

..The guidelines were to encompass value of clinical presentation, value of supplementary diagnostic tests, surgical management, and outcome assessment...

..0001). Pupil reactivity was more robust between these time points. It is recommended that the study hospital enrollment GCS and pupil reactivity be used for prognostic analysis...

..05). Attenuation of the ischemia-induced AQP4 up-regulation by PMA suggests that the reduction in brain edema formation following PMA treatment was at least in part mediated by AQP4 modulation...

..Taking these findings in concert, it is concluded that the predominant form of edema responsible for brain swelling and raised ICP is cellular in nature...

..To our knowledge, this is the first study to confirm that periventricular lucency seen on MRI represents increased water content in the extracellular space that is markedly elevated prior to shunting...

..In absence of secondary insult, rapid evacuation of traumatic SDH limits exposure to high ICP, reduces brain edema and is beneficial...

..With use of the CPP concept of treatment, the major contribution to CPP shifted to ICP and arterial hypotension played less of a role. Overall, CPP management has been associated with improved outcome...

..We therefore suggest that an intravascular route may be better for CsA administration because the intrathecal injection may exacerbate brain edema as found in our previous study...

..The goal of this study was to examine the roles of cerebral blood volume (CBV) and edema in traumatic brain swelling...

..NAA recovers if the degree of injury is moderate and not accompanied by secondary insult. The highly similar time course and correlation between NAA and ATP supports the notion that NAA reduction is related to energetic impairment...

..It is possible therefore that subgroups of patients exist who experience adverse effects of vasopressor treatment, and consequently the effects of vasopressor therapy in the clinical setting need to be more carefully evaluated...

..The prognostic value of NAA/Cr to assist in management and also to serve as a surrogate endpoint for clinical trials appears promising...

..This substance offers a new avenue in brain edema treatment and prompts further study into AQP4 modulation...

..An awareness of this procedural error and methods to reduce misclassification should be incorporated in TBI clinical trials...

..NAA decreases and remains low in patients with poor outcome. NAA recovers in patients with favorable outcome, suggesting marginal metabolic impairment and possible re-synthesis of the NAA pool...

..26). The consistent positive trends seen in ICP, TIL, neuropsychological tests, and, most importantly, 3- and 6-month GOS provide supportive evidence that a bradykinin antagonist may play a neuroprotective role in severe brain injury...

..Under this situation, the rapid evacuation exacerbated brain edema. These results have clinical implications for the management of severe traumatic SDH, especially its operative indication and timing...

..Secondary insult after traumatic SDH was associated with significant brain swelling and stimulated refractory rise in ICP. In traumatic SDH complicated by secondary insult, brain swelling is exacerbated by surgical evacuation...

..To study the effects of an externally applied negative abdominal pressure device designed to lower the effects of intra-abdominal pressure (IAP) on headaches and pulsatile tinnitus in severely obese women with pseudotumor cerebri (PTC)...

..CONCLUSION: The treatment of INPH should not be considered lightly, given the seriousness of the potential complications. Within these limitations and the available evidence, guidelines for surgical management were developed...

..In this study the authors used magnetic resonance (MR) imaging techniques to identify the type of edema that occurs in patients with TBI...

..Given that no data exist about the temporal profile of cerebral S100B levels following TBI and their correlation to serum levels, the authors examined whether proton magnetic resonance (MR) spectroscopy is capable of measuring S100B...

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..The data suggest that a collective effort can be made to minimize inter-rater variation...

..The objective of this study was to test this hypothesis in severely injured patients (GCS 8 or less) by obtaining simultaneous measures of CBF and NAA...

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..This baseline study supports the need for patient education regarding seizure emergencies and wider availability of at-home treatment options to shorten time to seizure treatment...

..The basic types of edema--vasogenic and cytotoxic--were classified 50 years ago, and their definitions remain intact...

..6% (45/84), 58.8% (50/85), and 62.1% (54/87) of patients, respectively. These patients, most of whom were refractory to other AEDs, generally had positive experiences with zonisamide...

..The results also indicate that the number of categories should be carefully determined using the pilot data or the data from phase II trials...

..Factors other than age, motor score and pupil reactivity over time are responsible for this reduction. This reduction over time is an important factor for prognostic modeling of TBI...

..We conclude that DMSO as a vehicle for drug administration may increase the drug concentration into the extracellular space, but since BBB permeability is increased, it may also provide an avenue for development of vasogenic edema...

..5%). With proper diagnosis and management of iNPH, shunting of patients is associated with a favorable risk/benefit ratio that is reasonably long lasting...

..It became clear that more prospective randomized studies are needed to resolve some of the controversial issues such as iNPH classification and sensitivity of diagnostic tests for identifying shunt responsive iNPH...

..These results suggest that these models may be potentially useful to study the combination of DBI and SDH with or without hypoxemia...

..Several examples will be given to strengthen the notion that we must not abandon the translational aspect of research but to embrace the process if we are to further improve outcome from brain injury...

..These initial findings suggest that ApEn may be a useful adjunct measure of the ICP waveform...

..021). A downregulation of AQP4 in the ischemic area paralleling the reduction in brain edema formation following PMA treatment suggests that the effect was mediated by AQP4 modulation...

..CONCLUSIONS: Analysis of these results indicates that ischemia and TBI are sublethal in isolation; however, when TBI is associated with secondary ischemia, ion dysfunction is sustained and is associated with elevated ICP...

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..We sought to better determine the safety profile of this lower concentration through a multicenter evaluation of adverse events reported by all centers currently performing xenon/CT studies in the US...

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..These data also suggest that restoration of BBB integrity after injury may be an energy dependent process. These findings have important implications for the pathophysiology of ICP elevations following cerebral contusion...

..We, therefore, examined whether the selective V1a receptor antagonist, SR49059, reduces brain edema by modulating AQP4 expression following cortical contusion injury (CCI)...

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..This paper is an attempt to summarize the key points made at the workshop. It is hoped that these lessons will enhance the planning and design of future efforts in this important field of research...

..To address this issue, a dose-response trial that would investigate the effects of Anatibant on the incidence of raised ICP and on functional outcome in severe TBI patients is needed...

..CONCLUSIONS: Our results indicate that the flexible ISE is a reliable and accurate tool for monitoring ionic dysfunction that accompanies brain injury...

..To investigate if edema formation is affected by the reduction of AQP4 expression, we utilized PMA and SR49059 following middle cerebral artery occlusion model (MCAo), and measured AQP4 expression by Western-Blot (WB) techniques...

..These findings suggest that ANP administration exacerbates brain edema after the experimental cortical contusion in rats, possibly because of an increase in the BBB permeability via cGMP pathway, whereas it reduces brain sodium levels...

..60-0.78). Higher glucose values were associated with increasing age, but on adjusted analysis, the strength of the association with outcome remained. Whether treatment of abnormal values may improve outcome needs further rigorous study...

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..Recommendations were made for enhancing the utility of available or emerging tools in order to facilitate implementation of a pathoanatomic classification approach for clinical trials...

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..The occurrence of secondary insults prior to or on admission to hospital in TBI patients is strongly related to poorer outcome and should therefore be a priority for emergency department personnel...

..We conclude that both the CT classification and individual CT characteristics are important predictors of outcome in TBI. For clinical trials, a central review process is advocated to minimize observer variability in CT assessment...

..Our finding of a smooth relationship with improving outcome as SBP increases up to 135 mm Hg, while not supporting a strong causal inference, does suggest that current guidelines need to be reconsidered...

..We critically reviewed the use of two types of secondary analyses, covariate adjustment and subgroup analysis, which are common in TBI trials...

..The high discriminative ability indicates the potential of this model for classifying patients according to prognostic risk...

..There are, however, some unresolved issues and potential risks to this therapy...

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..Many of our approaches are based on simple graphical displays of the data, but, where appropriate, we have also used methods that although established in the statistical literature are relatively novel in their application to TBI...

..We hope that these criteria will be widely applied in clinical practice and will promote greater consistency in patient selection in future clinical investigations involving INPH...

..We conclude that outcome following TBI is dependent on age, race, to a lesser extent on education, but not on gender...

..Falls were found to be associated with an older age and with a higher incidence of mass lesions. Following adjustment for age in the analysis, the relationship between cause of injury and outcome was lost...

..The approach raises issues of clinical, statistical, and regulatory importance, and we initiate what we believe needs to become a widespread debate amongst the community involved in clinical research in head injury and stroke...

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..The goal of this study was to characterize a new model of an epidural mass lesion in rodents by means of neurophysiological monitoring, magnetic resonance imaging, and histopathological analysis...

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..The goal of this study was to examine the roles of cerebral blood volume (CBV) and edema in traumatic brain swelling...

..Guidelines for outcome assessment were developed on the basis of the available evidence and consensus of expert opinion...

..The satisfactory discrimination indicates that logistic regression models, developed on large samples, can be used for classifying TBI patients according to prognostic risk...

..Taken in concert, these studies will provide a more indepth understanding of the role of aquaporins in brain injury and introduce novel therapeutic approaches for treating brain edema. ..