Day :
- Brain Injury | Brain Injury Treatment | Neurological Disorders
Location: Chambers Suite
Chair
Fontaine H Guy
Pitié-Salpêtrière Hospital, France
Session Introduction
Androulis Antonios
National and Kapodistrian University of Athens, Greece
Title: Hypothermia for intracranial hypertension after Traumatic Brain Injury: A randomized clinical study
Time : 12:50-13:20
Biography:
A Androulis is a qualifi ed Neurosurgeon operating as Complex Spine Fellow at the 2nd Neurosurgical department of Attikon University Hospital and Director of Neurosurgery at IASO General Private Hospital. He is currently pursuing his PhD at National and Kapodistrian University of Athens, Greece. His research work focuses on issues of cerebrospinal surgery and in vitro models for studying neurodegenerative and immunosuppressive neuropathies.
Abstract:
Background: Most patients with heavy traumatic brain injury (TBI) are nursed in ICUs. Clinical trials indicate significant mortality and morbidity in cases with sustained increases in intracranial pressure (ICP). A current way of controlling intracranial pressure in ICU is therapeutic hypothermia. The benefit of hypothermia on functional outcome is unclear.
Methods: 26 patients were randomly enrolled in the experimental group and 26 patients in the control group. Patients in the experimental group (n=26) were subjected to therapeutic hypothermia and monitored by 24 hour-recording of temperature and intracranial pressure. In control group (n=26), 24 hours recording of body temperature ​​and intracranial pressure was also performed but without the use of therapeutic hypothermia. Patient recording ranged from 1 to 6 days.
Results: There were 1638 hourly measurements of intracranial pressure in the control patient group. ICP exceeded ≥ 15 mmHg in 1192 of these hourly measurements while in remaining 446 values ranged from 8-14 mmHg. In experimental group, 2.208 hourly ICP measurements were performed. ICP values exceeded ≥15 mmHg in 685 and ranged from 5-14 mmHg in 1523 hourly measurements. The effect of therapeutic hypothermia was found significant (F=14.34, p=0.000).
Conclusions: Our investigation showed that therapeutic hypothermia can be used as an additional form of treatment of intracranial hypertension although the benefit in secondary injuries when patient intracranial pressure was ≥ 20 mmHg remains unclear. In particular, in patients with ICP>20 mmHg after TBI, therapeutic hypothermia does not improve results than the traditional form of care.
Junzo Nakao
Tsukuba Medical Center Hospital, Japan
Title: Intantional normothermia used by intravascular cooling system for severe Brain Injury A retrospective study
Time : 14:10-14:40
Biography:
Junzo Nakao has completed his PhD at University of Tsukuba, Japan. He has his expertise in Neurotrauma and Neurointensive Care. He has published more than five papers in reputed journals
Abstract:
Aim: Acute hyperthermia of severe brain injury causes secondary brain injury and aggravate outcome of patients. Therefore, maintenance of normothermia is recommended for severe brain injury in the acute phase. Therefore, we use cooling blanket (CB) for maintenance of normothermia in Japan. Aim of this study is to report that maintenance of normothermia by intravascular cooling system (ICS) for severe brain injury in the acute phase and compare the effect of ICS with CB. Method: Six patients with severe brain injury were given normothermia after soon surgery from January 2016 to November 2016. Result: Two cases were maintained by CB and four cases were maintained by ICS. All cases were given craniotomy for removal intracranial hematoma. Average GCS in-hospital of CB group was five and that of ICS group was 6.25. Average time-to-target temperature of CB group was 305 minutes and that of ICS group was 103.5 minutes (p<0.01). Patient’s temperature of ICS group was more comfortable than that of CG group. GOS was not significantly different between groups (GOS of CB group was 3.5 and that of ICS group was 2.5). Discussion: ICS has the potential of effective temperature control system because it is able to get target temperature quickly and effectively. On the other hand, it has the risk of complication; for example, infection and clot formation and so on. We need to accumulate more cases to find ICS to be effective.
Getachew Desta Alemayehu
Bahirdar University, Ethiopia
Title: Craniopagus parasiticus-parasitic head protuberant from temporal area of cranium: A case report
Time : 14:40-15:20
Biography:
Getachew Desta completed his Doctor of Medicine at Gondar University and has one and half years of working experience as a Lecturer at Bahir Dar University, Ethiopia. Currently, he is a fourth year Resident in Surgery at Bahir Dar University.
Abstract:
Background: Craniopagus parasiticus is a rare medical case and it is unique unlike other cases reported from different literature. The head of parasitic twins is protruding from the temporal area of cranium. Parasitic head has two deformed lower limbs; one is too rudimentary attached to the mass; long bones of bilateral lower limbs and some pelvic bones. After dissection of the mass, the intestine was seen but no chest organs and other abdominal organs. There is also rudimentary labium but no vaginal opening.
Case Presentation: A 38-years-old multigravida (gravida V para IV) women from Amhara ethnicity referred from rural health center to referral hospital due to prolonged second state of labor at 42+1 weeks. Upon arrival, she had contraction, term sized gravid uterus and fetal heart beat was 112. On digital pelvic examination, the cervix was fully diluted; station of the head was high and the pulsating umbilical cord coming in front of the presenting part with ruptured membrane but yet in the vaginal canal. The team decided emergency cesarean section and then a live female infant weighing 4200 g was delivered. The placenta was single and normal. The APGAR scores were seven and nine at 1 and 5 min, respectively. The infant appeared to be grossly normal except the parasitic co-twin attached at the cranium. The neonate was investigated with the available investigations (CBC, X-ray, Doppler ultrasound) and pediatric side consultation was made. After a week of counseling and investigations, successful separation operation was done. During post-operative time, the neonate comfortably suckled on breasts without neurological deficit. The details of the surgery, post-operative condition & subsequent follow up will be discussed during the conference.
Conclusion: The possible etiologies of craniopagus parasiticus are still unknown due to a rarity of cases. Doctors, Genetic Scientists, Epidemiologists and Researchers continue to investigate this case as the reasons that could give clue to birth defect and to provide answer for better prognosis of cases and improved the life chances of the twins. This case will have some input in the effort to know the etiology and pathogenesis of this new borns.
- Workshop
Location: Chambers Suite
Session Introduction
Suresh Kumar
Headache, Tbi & Memory Research Institute, USA
Title: Late seizures in mTBI: A prospective study
Biography:
Suresh Kumar is a Triple Board Certified Brain Injury Specialist, Neurologist and Director of Headaches, TBI and Memory Research Institute in Southern USA. He completed his Residency training in Neurology from Louisiana State University and later board certification in Headaches Medicine & Traumatic Brain Injury Medicine. He is User Interface Software Architect; Neuro Scientist & Clinician operating research based clinical practice. He has helped more than 50 patients with memory impairment after TBI and mild to moderate dementia under Regain Memory 360 protocol approach. He has published and presented many abstracts and papers on diagnosis, treatment of mild traumatic brain injury and cognitive deficit.
Abstract:
Objective: Persistent symptomatic mild traumatic brain injury (mTBI) is a focal disease process. Almost 80% of the patients have spontaneous resolution after mTBI, but 5 to 10% who have persistent mTBI disease presented to our clinic with persistent symptoms. The study was conducted on this group of patients with symptoms after mTBI for more than one month. Abnormal EEG results increase with persistent symptoms as the focal abnormalities increase due underlying focal shear brain cell injury. Aim of this study is to study predictor of late complications of seizure after episodes mTBI.
Method: A perspective study of patients presented to a TBI clinic for five years was conducted. On initial visit after neurological evaluation and detail questioning about the history of the mTBI and possible seizure semiology with strict inclusion criteria, a montreal cognitive assessment (MoCA) was administered to patients. Following neurological evaluation, a one-hour routine EEG as a standard protocol was performed after four weeks of the mTBI.
Results: 202 patients (105 females and 97 males with an average age of 42 years) presented and followed over three years after mTBI. Total 14 patients (6.9%) had seizures and 12 (5.9%) late seizures with average time of 22 months. 8/14 (57%) patients experienced complex-partial seizures and 6/14 (42%) encountered partial seizures episodes. 11/14 (78%) had recurrent seizure episodes while three patients had single episodes. 111/202 (55%) experienced transient LOC and 35/202 (12.4%) patients had abnormal focal EEG reports. 24/35 (68.6%) patients had an abnormal EEG and LOC. 12/14 (85.7%) patients had abnormal EEG results in predominantly frontal and temporal lobes, but only 10/14 (71.4%) of those also had LOC. On further analysis, LOC has a relative risk of 81.8% for future seizure episodes. Abnormal EEG is 37.14% directly correlated with seizures and 20.12% related with memory loss (P<0.0392). LOC is 5.35% related with memory loss (P<0.0412). The relative risk was 6.15, the patients who experienced seizures after the mTBI were six times more likely to have an abnormal EEG than those who did not experience any seizures. The sensitivity of the EEG at discovering abnormal brain wave-like activity was 85.7% with LOC group.
Conclusion: We do not have any standard protocol for recommendation and follow up after mTBI and to determine the late risk of seizure. From our study, loss of consciousness, abnormal EEG and memory loss are directly correlated with each other after mTBI and the abnormal EEG will increase the risk of late seizure in mTBI patients. Persistent symptomatic mTBI needs further testing with EEG to define future risk of seizure or increase risk of memory loss. The late risk of seizure after mTBI from this study was 6.9% and had an onset up to six years.
Method: A perspective study of patients presented to a TBI clinic for five years was conducted. On initial visit after neurological evaluation and detail questioning about the history of the mTBI and possible seizure semiology with strict inclusion criteria, a montreal cognitive assessment (MoCA) was administered to patients. Following neurological evaluation, a one-hour routine EEG as a standard protocol was performed after four weeks of the mTBI.
Results: 202 patients (105 females and 97 males with an average age of 42 years) presented and followed over three years after mTBI. Total 14 patients (6.9%) had seizures and 12 (5.9%) late seizures with average time of 22 months. 8/14 (57%) patients experienced complex-partial seizures and 6/14 (42%) encountered partial seizures episodes. 11/14 (78%) had recurrent seizure episodes while three patients had single episodes. 111/202 (55%) experienced transient LOC and 35/202 (12.4%) patients had abnormal focal EEG reports. 24/35 (68.6%) patients had an abnormal EEG and LOC. 12/14 (85.7%) patients had abnormal EEG results in predominantly frontal and temporal lobes, but only 10/14 (71.4%) of those also had LOC. On further analysis, LOC has a relative risk of 81.8% for future seizure episodes. Abnormal EEG is 37.14% directly correlated with seizures and 20.12% related with memory loss (P<0.0392). LOC is 5.35% related with memory loss (P<0.0412). The relative risk was 6.15, the patients who experienced seizures after the mTBI were six times more likely to have an abnormal EEG than those who did not experience any seizures. The sensitivity of the EEG at discovering abnormal brain wave-like activity was 85.7% with LOC group.
Conclusion: We do not have any standard protocol for recommendation and follow up after mTBI and to determine the late risk of seizure. From our study, loss of consciousness, abnormal EEG and memory loss are directly correlated with each other after mTBI and the abnormal EEG will increase the risk of late seizure in mTBI patients. Persistent symptomatic mTBI needs further testing with EEG to define future risk of seizure or increase risk of memory loss. The late risk of seizure after mTBI from this study was 6.9% and had an onset up to six years.
- Traumatic Brain Injury | Case Reports and Case Management of Brain Injuries
Location: Chambers Suite
Chair
Suresh Kumar
Headache, Tbi & Memory Research Institute, USA
Session Introduction
Esther M Remeta
Chiropractic Research Institute, USA
Title: Chiropractic cranial treatment protocol increases successful outcome of the multidisciplinary care model for Traumatic Brain Injury (TBI) patients: A case series
Biography:
Esther M Remeta is a practicing Chiropractor and Clinical Researcher. She is currently the Executive Director at Chiropractic Research Institute (CRI) in Clemmons. She completed her Doctor of Chiropractic Degree at National College of Chiropractic in Illinois. She is a SOTO-USA Board Certified Sacro Occipital Technique and Craniopathy Practitioner and a Diplomat with the American Academy of Pain Management.
Abstract:
Introduction & Aim: This article seeks to share a novel manner of multidisciplinary care which incorporates allopathy, chiropractic, psychology, acupuncture, neurorehabilitation and nutrition for the treatment of TBI. Case 1: A 28-year-old female suffered TBI from a violent attack resulting with severe debilitating headaches requiring daily bed rest for two years with her condition consistently devolving prior to initial office visit. She was diagnosed with chronic migraines and informed that she would need prescription medication the rest of her life. Case 2: A 30 year old female sustained a TBI from a motor vehicle accident. PET scans noted decreased bilateral occipital lobe metabolic activity. She had chronic headaches of two year duration with transient paralysis of her left extremities and short term memory loss. She was informed by her neurologist that due to the duration of her post-concussion syndrome that no recovery could be expected. Case 3: A 70 year old male suffered a TBI from a stroke causing complete paralysis of the right upper and lower extremity. He also suffered from swallowing difficulty and speech problems. His neurologist had informed him that he would never work again, would need to walk with assistance, and have compromised use of his right hand.
Treatment/Intervention: A focal point of this multidisciplinary care at this clinic is sacro occipital technique (SOT) cranial manipulation protocols along with specific neurological rehabilitation training and home exercises. Home therapy focuses on physical, mental and emotional balance which increases efficacy of treatment. The care model is implemented for a minimum of one year with most patients remaining in the model for five years.
Results: Case 1: When treatment began, there was a significant initial improvement along with a gradual increase in function so that two years later (one treatment per week) headaches occur only once every two weeks lasting 12 hours. She is off all 10 of her prescription medications except for one and is currently tapering off of it under medical supervision. She is now able to live a more normal life with her young eight year old daughter taking part in her life activities as well. Case 2: After five years of treatment (one time per week), she is headache free, has neither short term memory loss nor any paralysis episodes. Case 3: After nine months of care, he was back at work full time and without paralysis, speech or swallow problems. After five years of care (one treatment per week), there were no obvious symptoms associated with the left parietal lobe infarct despite brain MRI scans showing damage was still present.
Interventions/Outcomes: A focal point of this multidisciplinary care at this clinic is sacro occipital technique (SOT) cranial manipulation protocols along with specific neurological rehabilitation training and home exercises over a five-year period. Significant improvement was noted in all cases with length of care varying from eight months to five years.
Conclusion: This care model gives greater hope for those suffering from TBI as well as gives the health care profession at large more options to create treatment plans resulting in better prognosis.
Biography:
Arun Kumar Prasad is a student of Department of Neurology at Taishan Medical University, China. He has published more than three papers in reputed journals and conferences in the field of Brain Injury.
Abstract:
Recent studies suggest that central nervous system (CNS) lymphatic drainage pathway to extracranial lymph compartments may play an important role in the removal of substances in the brain and cerebrospinal fluid (CSF). After the onset of subarachnoid hemorrhage (SAH), large amount of macromolecular substances, such as cellular lysates, proteins, peptides were accumulated in the brain tissue and CSF, which contribute to cerebral vasospasm and cerebral injury. The present experiment was carried out to investigate the possible role of cerebral lymphatic drainage pathway in the development of cerebral vasospasm and related cerebral injury and the influence of Ginkgo biloba extract. Wistar rats were used in the experiment and animals were divided into different groups. SAH models were replicated by double cisternal injection of autologous arterial hemolysate. In some animals, the main cerebral lymphatic drainage way out being blocked (cerebral lymphatic blockade, CLB). Two different constituents, ginkgolides and ginkgo flavone, were given as interventions. It was found that SAH reduced the drainage of Evans blue-labeled albumin (EBA) from the brain to the olfactory bulbs, cervical lymph nodes and abdominal paraaortic lymph nodes. A kinetic analysis of 125I-labeled human serum albumin (125I-HSA), a cerebrospinal fluid (CSF) tracer, showed that the clearance rate of macromolecules in the CSF was significantly reduced after SAH. Furthermore, SAH reduced the diameters of basilar artery (BA) and increased thickness of BA. Prominent cerebral injury was found after induction of SAH. The spasm of BA and cerebral injury were partially antagonized by ginkgolides and ginkgo flavone. It was concluded that cerebral lymphatic drainage pathway exerts intrinsic protective effects against cerebral vasospasm and cerebral injury by removal of macromolecular substances in the brain and subarachnoid spaces. Ginkgolides and ginkgo flavone may alleviate the exacerbated cerebral vasospasm and cerebral injury following SAH by CLB.
- Brain Disorders | Brain Therapeutics | Neurosurgery
Location: Chambers Suite
Chair
Aguinaldo Pereira Catanoce
Pontifi cia Catholica University of Campinas, Brazil
Session Introduction
Aguinaldo Pereira Catanoce
Pontifi cia Catholica University of Campinas, Brazil
Title: Held important development with the description and improvement of surgical treatment of pituitary tumor through video - endoscopic technique
Biography:
Aguinaldo Pereira Catanoce completed his Graduation and Post-graduation in Medicine and Neurosurgery at Catholic University of Campinas in Brazil in 2007. He is a member of Brazilian Society of Neurosurgery since 2009. He has eight years of experience in “Neurosurgery and video endoscopes for brain tumors at the base of skull and intra-ventricular area in addition to the improvement of microsurgical treatment of vascular lesions”. He is a Neurosurgeon and Professor in Department of Neurosurgery at University of Campinas, Brazil; Manager; Medical and Technical Director at University Hospital, São Paulo, Brazil with seven years of experience in Hospital Management.
Abstract:
This paper reports about the important development with the description and improvement of surgical treatment of pituitary tumor through video-endoscopic technique. This video-endoscopic technique describes the endoscopic fully endonasal transsphenoidal surgery for pituitary tumors. A series of, over 120 cases, of procedures over last seven years, in a particular and University Hospitals in Brazil were included in this study. It described statistics biochemical, clinical and radiologic results with a specific radiologic pre and post- operative image. An angiotopographic bone study for sphenoid sinus details and magnetic brain image is used. In the fully endonasal endoscopic technique, we encountered less morbidity/mortality statistics and more patient satisfaction. The advancements of fully endoscopic endonasal surgery of pituitary adenomas lead to a better endocrinologic clinical and radiologic control, less morbidity.
Androulis Antonios & Derventzi Anastasia
National and Kapodistrian University of Athens, Greece
Title: Osteopontin as indicator of Traumatic Brain Injury severity and progression
Biography:
A Androulis is a qualified Neurosurgeon operating as Complex Spine Fellow at the 2nd Neurosurgical department of Attikon University Hospital and Director of Neurosurgery at IASO General Private Hospital. He is currently pursuing his PhD at National and Kapodistrian University of Athens, Greece. His research work focuses on issues of cerebrospinal surgery and in vitro models for studying neurodegenerative and immunosuppressive neuropathies.
Abstract:
Background: Most patients with heavy traumatic brain injury (TBI) are nursed in ICUs. Clinical trials indicate significant mortality and morbidity in cases with sustained increases in intracranial pressure (ICP). A current way of controlling intracranial pressure in ICU is therapeutic hypothermia. The benefit of hypothermia on functional outcome is unclear. Methods: 26 patients were randomly enrolled in the experimental group and 26 patients in the control group. Patients in the experimental group (n=26) were subjected to therapeutic hypothermia and monitored by 24 hour-recording of temperature and intracranial pressure. In control group (n=26), 24 hours recording of body temperature ​​and intracranial pressure was also performed but without the use of therapeutic hypothermia. Patient recording ranged from 1 to 6 days. Results: There were 1638 hourly measurements of intracranial pressure in the control patient group. ICP exceeded ≥ 15 mmHg in 1192 of these hourly measurements while in remaining 446 values ranged from 8-14 mmHg. In experimental group, 2.208 hourly ICP measurements were performed. ICP values exceeded ≥15 mmHg in 685 and ranged from 5-14 mmHg in 1523 hourly measurements. The effect of therapeutic hypothermia was found significant (F=14.34, p=0.000). Conclusions: Our investigation showed that therapeutic hypothermia can be used as an additional form of treatment of intracranial hypertension although the benefit in secondary injuries when patient intracranial pressure was ≥ 20 mmHg remains unclear. In particular, in patients with ICP>20 mmHg after TBI, therapeutic hypothermia does not improve results than the traditional form of care.
Anatoly B Uzdensky
Southern Federal University, Russia
Title: Involvement of calcium-dependent signaling in the axotomy-induced death of satellite glial cells
Biography:
Anatoly B Uzdensky is a Head of the Laboratory of Molecular Neurobiology at Southern Federal University, Russia. He completed his PhD and Doctor of Science Degree in Physiology and Biophysics in 1980 and 2005, respectively. He is the Author of about 120 journal papers and four books. His current research interests include Neuroscience, Neuro-degeneration and Neuroprotection, Stroke, Cell-signaling and Proteomics.
Abstract:
Neurons and satellite glia mutually support survival of each other, but signaling processes that control their life and death after axotomy (AT) are insufficiently explored. We used a simple model object- axotomized crayfish mechanoreceptor consisting of single sensory neuron surrounded by glial envelope. Control: Undamaged mechanoreceptor that saved connection with abdominal ganglion. Necrosis and apoptosis of glial cells increased at 8 hours after AT when death of neurons was not detected yet. 3-fold increase in [Са2+]o induced glial apoptosis in axotomized but not control samples. Unexpectedly, glial necrosis decreased in 3[Са2+]o, but increased in (1/3)[Са2+]o. Inhibition of endoplasmic reticulum Ca-ATPase (SERCA) by thapsigargin induced glial apoptosis after AT but not in control. Calcium ionophore ionomycin induced glial apoptosis both after AT and in control samples. Fluphenazine, inhibitor of calmodulin did not influence glial apoptosis, but induced glial necrosis. Dantrolene and ochratoxin A that release Ca2+ from endoplasmic reticulum stimulated AT-induced glial apoptosis but not necrosis. The blockage of mitochondrial permeability pores with cyclosporine A, which prevented calcium release from mitochondria, reduced cell death. Thus, AT combination with high [Са2+]o or with activation of pathways increased [Са2+]i induced apoptosis of glial cells. Decrease in [Са2+]o, inhibition of SERCA, calmodulin, or Ca2+ ionophore promoted glial necrosis. Blockage of mitochondrial permeability pores protected glia from axotomy-induced death. So, axotomy induces necrosis and apoptosis of satellite glial cells and Ca2+ is involved in the detrimental effect of AT.
Wei-Chun HSU
National Taiwan University of Science & Technology, Taiwan
Title: Comparison of Temporal-Spatial Gait Variabels and Joint Kinematics Between Stepping Exercise and Walking Pattern in Patients with Stroke – a Pilot Study
Biography:
Wei-Chun Hsu received the B.S. degree in physical therapy in 1998, and the M.S. degree in Mechanical Engineering from National Paris XII University, France, in 2000, and the Ph.D. degree in biomechanical engineering in 2009 from the National Taiwan University. After several years working as physical therapist in Shin-Kong hospital and one year working as post-doctoral Research Fellow at National Taiwan University, she joined National Taiwan University of Science and Technology where she is now Associate Professor at Graduate Institute of Biomedical Engineering. Her research interests include motion analysis, rehabilitation engineering, sports science, motor control and learning, and biomechanics.
Abstract:
Recumbent seated stepper exercise is becoming popular for the lower extremity rehabilitation as it is than upright cycling and treadmill walking and thus is an ideal exercise option. Two patients with stroke were invited to participate in the experiments. Passive markers were placed on the pelvis and lower limbs while ultra-high resolution infrared cameras (Qualisys, 700+, Sweden) were used to perform motion capturing when stepping and walking. In comparisons with stepping and walking, the stepping task had shorter pushing phase compared with the corresponding weight-bearing stance phase of walking. Hip angle kept flexed throughout the stepping phase which was very different from those during level walking. The pattern of knee angular displacement during pushing phase were not similar to those during stance phase of level walking; while the peak flexion pattern found during returning phase was similar the necessity of a prominent peak found during swing phase of the walking condition. Although the swing phase of walking and returning phase of stepping were fundamentally different due to the weight bearing condition, non-weight bearing for the walking and partial weight bearing for the steeping tasks, this peak might be helpful to transfer the ability of flexion movement of the knee joint during training to a sufficient foot clearance during swing phase of level walking. Ankle angle had an opposite direction of movement during these two motions. As a whole, the patterns of stepping and level walking were different except the swing/retuning phase of walking/stepping.
Dimitris E. Papageorgiou
General Hospital of Athens “G. Gennimatasâ€, Greece
Title: Hypothermia for intracranial hypertension after traumatic brain injury: A randomized clinical study
Biography:
Dimitris E. Papageorgiou is a lecturer in the Department οf Nursing B' of the Faculty of Health and Caring Professions of Athens. He graduated from the Department of Nursing B’ of the Technological Educational Institution of Athens as well as from the Department of Nursing of the University of Athens. He holds a Master’s degree in Nursing from the University of Cardiff and a doctorate diploma from the Faculty of Medicine of the University of Ioannina. He has worked as a visiting lecturer in the Faculty of Nursing of the University of Peloponnese and of the Technological Educational Institution of Larissa. He is member of the editorial Board of Nursing Journal.
Abstract:
Background: Most patients with heavy traumatic brain injury (TBI) are nursed in ICUs. Clinical trials indicate significant mortality and morbidity in cases with sustained increases in intracranial pressure (ICP). A current way of controlling intracranial pressure in ICU is therapeutic hypothermia. The benefit of hypothermia on functional outcome is unclear.
Methods: 26 patients were randomly enrolled in the experimental group and 26 patients in the control group. Patients in the experimental group (n=26) were subjected to therapeutic hypothermia and monitored by 24 hour-recording of temperature and intracranial pressure. In control group (n=26), 24 hours recording of body temperature ​​and intracranial pressure was also performed but without the use of therapeutic hypothermia. Patient recording ranged from 1 to 6 days.
Results: There were 1638 hourly measurements of intracranial pressure in the control patient group. ICP exceeded ≥ 15 mmHg in 1192 of these hourly measurements while in remaining 446 values ranged from 8-14 mmHg. In experimental group, 2.208 hourly ICP measurements were performed. ICP values exceeded ≥15 mmHg in 685 and ranged from 5-14 mmHg in 1523 hourly measurements. The effect of therapeutic hypothermia was found significant (F=14.34, p=0.000).
Conclusions: Our investigation showed that therapeutic hypothermia can be used as an additional form of treatment of intracranial hypertension although the benefit in secondary injuries when patient intracranial pressure was ≥ 20 mmHg remains unclear. In particular, in patients with ICP>20 mmHg after TBI, therapeutic hypothermia does not improve results than the traditional form of care.
Biography:
Abbas Alnaji completed his Degree in Neurosurgery FICMS NS from University of Baghdad 1999. He is interested in research work and have twelve papers published in the field of Surgical Pathology Causations.
Abstract:
Introduction: Neurosurgeons often faces many complications after head injuries, one of these complications is '' low grade meningitis'' which of normal and sterile CSF and does not responds to empirical antibiotic treatment ( e.g. combinations of betalactams ).
Aim: To reveal the nature and show the incidence of a hiding pre-traumatic pathologic agent that causes many post traumatic events one of them is our subject here the " Low grade meningitis".
Method and patients: Over 20 years of my career I found near to one third of head injured patients of all ages and both genders who recovered from any trauma severity at least in Iraq and two other Arabian countries show features of low grade meningitis either they show it as they regain consciousness or very short period of 2-3 days after head injury with or without history of loss of consciousness. Features are very variable could be all, or some of them available, and could be rising with time or stationary; Head ache, photophobia, irritability in pediatric age group, anorexia, intermittent low grade fever, periodic malaise, meningism, Babinski, kernig's sign and brudzinski's sign and reflex (or simply neck stiffness), CT scan is negative for SAH, CSF nearly normal , CSF C/S is sterile for bacteria and AFB (Tb), culture is difficult for Brucella around us . CSF sample is negative for TB in PCR not done for Brucella due not available in general hospital and expensive in private sector . As a traditional work in or centers in Iraq and some of Arabic countries I work in the patient is either already on wide a spectrum betalactam antibiotics as a prophylaxis ( amoxicillin and cefitrioxone of different doses) or he put on them when developed such a picture. Results: patients do not respond to such regimen for long time even when amoxicillin is replaced by vancomycin. While very good and dramatic response when patients are given Doxycyclin and cotrimoxazole when above six years and cotrimoxazole alone or Azothromycin plus cefixime in usual doses below six years.
Discussion: This interpretation was born from two facts; First, as I am originally interested in the biological bases for the surgical pathologies which gave me a good visions to many events as long as I proceed in this prospect. The Second, intermittent or undulant low grade fever if present !! relative good general health of the patient in presence of the above mentioned clinical picture generally give a clue to presence of a pre-traumatic opportunistic hiding infection, or it might be presented differently, but the community consider it either with normal limit, or an unexplained ill health triggered by simple exertion or by some other usual daily events ( in third world this is seen as low weight or any other feature like poor appetite before the trauma). For that the possible causative agent in this regard is chronic Brucellosis. We lack the PCR kits to prove it in public hospitals, serology is not dependable and it is negative in most of these patients who recovered dramatically. Other possible pathogens whom I enlisted need to be proved and discriminated from Brucella, but due to our severe shortage in modern lab aids we could not do so.
Conclusion: If this very successful trial treatment and concept is true !!! We need to re-direct our principles and efforts not to treat post traumatic meningitis successfully only, rather we to have look on the incidence of hidden pathologies which might be the same all over the world which forms an underestimated national hazards. HOW or why national hazards ?? because the one third of my patients over very long time ( 20 years ; 5 years as a resident and 15 as specialist) is a considerable number in any community general health considerations.
Recommendations: For me, I seek from interested organizations the aid to proceed with detection of the real causative agents with PCR and other modern lab techniques. Generally I depend on my personal resources which are not much, also on the patients when seeking my medical services in private sector which also is not much in a country suffers from crises for decades especially the present war on ISIS like Iraq. And I hope this mode of analysis and treatment is applied elsewhere if such complication is found, with knowledge sharing