RESUMEN
Traumatic brain injury (TBI) is a highly complex multi-factorial disorder. Animal models of TBI are used to elucidate primary and secondary injury mechanisms and pathophysiological changes and to provide the diagnostic and therapeutical basis for TBI. The choices of animal models depend upon the research objectives. However, various animal models have limitations. The models only can duplicate the pivotal injury mechanisms or a certain important pathophysiological course. The characteristics of human TBI can not fully be reflected by using these models. In the review, animal models of traumatic brain injury are classified as dynamic direct brain injury, indirect dynamic brain injury and combined neuro-traumatic models. Several common models are described for consideration.
Asunto(s)
Animales , Humanos , Ratones , Ratas , Fenómenos Biomecánicos , Encéfalo/fisiopatología , Lesiones Encefálicas/fisiopatología , Lesión Axonal Difusa/fisiopatología , Modelos Animales de Enfermedad , Medicina Legal , Traumatismos Cerrados de la Cabeza/fisiopatología , Traumatismos Penetrantes de la Cabeza/fisiopatología , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Cerebral perfusion pressure management (CPPM) is an accepted modality of treatment of severe diffuse head injury (SDHI). However, CPPM has the potential to cause transcapillary exudation in the presence of a disrupted blood brain barrier and can lead to further increase of intracranial pressure (ICP) and worsening of compliance. AIMS: This study attempts to evaluate the effect of both transient and prolonged changes in cerebral perfusion pressure (CPP) on ICP and cerebral compliance as measured by the Pressure Volume Index (PVI), and to correlate changes in PVI with outcome at 12 months using the Glasgow Outcome Score. SETTINGS AND DESIGN: Prospective study in a neurosurgical ICU. MATERIAL AND METHODS: Twenty-seven SDHI patients managed using standard protocol to maintain CPP above 70 mmHg. Mean arterial pressure (MAP), ICP and CPP were monitored every half-hour. Daily monitoring of the PVI and ICP was done before, and after the induced elevation of MAP using IV Dopamine infusion. The relationship between CPP, MAP, ICP, PVI and outcome was evaluated. STATISTICAL ANALYSIS USED: The paired and independent samples T-test, and the Pearson correlation coefficient. RESULTS: CPPM rarely leads to progressive rise in ICP. Maintaining CPP above 70mmHg does not influence ICP or PVI. Transient elevations in CPP above 70mmHg may produce a small rise in ICP. Trend of change in PVI influenced outcome despite similar ICP and CPP. CONCLUSION: Elevating the CPP above 70mmHg does not either reduce the ICP or worsen the compliance. Monitoring changes in compliance should form an integral part of CPPM.
Asunto(s)
Adulto , Presión Sanguínea/fisiología , Encéfalo/fisiopatología , Circulación Cerebrovascular/fisiología , Adaptabilidad , Femenino , Escala de Consecuencias de Glasgow , Traumatismos Cerrados de la Cabeza/fisiopatología , Humanos , Presión Intracraneal/fisiología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Resultado del TratamientoAsunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Algoritmos , Lesiones Encefálicas/complicaciones , Traumatismos Cerrados de la Cabeza/complicaciones , Lesiones Encefálicas/fisiopatología , Traumatismos Cerrados de la Cabeza/fisiopatología , Pronóstico , Edema Pulmonar/etiología , Estudios RetrospectivosRESUMEN
Säo apresentadas e discutidas as consequências neuropsicológicas dos traumatimos cranianos. O autor relata os sintomas e síndromes mais comuns e apresenta dois casos de síndrome de lobo frontal pós-traumática