A case of neurocysticercosis-differential diagnostic aspects.

Neurocysticercosis is no medical rarity but in non-endemic countries especially, a high degree of physician awareness is necessary for diagnosis. The case of a German female patient who had focal seizures for the first time at the age of 23 caused by a cerebral cyst of cysticercus cellulosae is presented. Only surgical removal and subsequent histological examination allowed diagnosis while diagnostic investigation yielded no pathological findings.

Elevated cerebral perfusion pressure and low colloid osmotic pressure as a risk factor for subdural space-occupying hygromas?

BACKGROUND: Space-occupying subdural hygromas are a late complication of severe traumatic brain injury (TBI) and may delay the patient's recovery. To evaluate the risk factors involved, we performed a semiretrospective, -prospective analysis of three groups of patients, which differed with regard to the techniques used in the management of their cerebral perfusion pressure (CPP) and colloid osmotic pressure (COP) to determine the occurrence of space-occupying subdural hygromas. PATIENTS AND METHODS: Between 1989 and 1997 we examined 696 patients after a severe TBI: Group 1. 1989-1994 mean CPP: 67 (elevated for therapeutic reasons by catecholamines, if necessary), mean COP: 19. Group 2. January 1995-October 1996, mean CPP: 77, mean COP: 20. Group 3. November 1996-December 1997, mean CPP: 79, mean COP: 23 (elevated for therapeutic reasons by infusions of colloids). The groups were comparable for other criteria. RESULTS: Compared to Group 1, Group 2, with a high CPP but lower COP, showed a significantly higher (p < 0.01; chi2-test with correction of Yates) percentage of posttraumatic subdural hygromas with space-occupying aspects, clinical signs of bradycardia, hypertension and impaired consciousness requiring surgery (Group 1: 1.75%; Group 2: 10.46%; Group 3: 0%). In Group 3 we saw no patient with a space-occupying hygroma. CONCLUSION: We conclude that iatrogenic elevated CPP, which has been reported to be helpful in preventing secondary ischemic damage after a severe TBI, may be harmful to a patient if the COP is not maintained within physiological ranges.

[Transcranial color-coded real time ultrasound. An improvement in patient monitoring in the neurosurgical intensive care unit?]. / Die transkranielle farbkodierte Real-Time-Sonographie. Eine Verbesserung der Patientenüberwachung auf der Neurochirurgischen Intensivstation?

It is still not always possible to detect in time early intracranial complications in neurosurgical critical care patients. In addition, the exact definition of the lesion requires an often life-threatening transport to the CCT. Hence, there is still a need for improved bedside monitoring. New developments in ultrasound technique enable us not only to get a two-dimensional image of intracranial parenchymatous structures through the intact bone but also to visualise, by means of colour-coding, the blood flow the intracranial vessels. In 70 mostly neurotraumatised patients we found that this method is helpful in solving diagnostic or therapeutic problems without the patient having to leave the intensive care unit.

Bedside measurement of the third ventricle's diameter during episodes of arising intracranial pressure after head trauma. Using transcranial real-time sonography for a non-invasive examination of intracranial compensation mechanisms.

Using transcranial real-time sonography, changes in the axial diameter of the third ventricle during manoeuvres, which increased intracranial pressure (ICP), were measured in 28 patients with moderate to severe head injury. The measurements were correlated with ICP measured by epidural pressure monitoring. We observed reductions in diameter ranging from 0.3 to 1.1 mm with rises in intracranial pressure of at least 5 mm in 22 patients of whom only one died. In 6 additional patients, no changes in diameter were seen, and 5 of the 6 died. We interpret that poor outcome as a measurable inability for the brain to expel cerebrospinal fluid into extracerebral compartments during increased ICP. Transcranial real-time sonography may provide additional information about intracranial cerebral fluid dynamics and compliance.