"Cerebral cardiovascular control: anatomical and physiological aspects, Catecholamine response to a gradual increase of ICP, Course of ICP changes in two models of progressive intracranial hypertension, Pathogenetic aspects of the hemodynamic changes during raised intracranial pressure, Summary and Conclusions."
Traumatic brain injury (TBI) remains a significant source of death and permanent disability, contributing to nearly one-third of all injury related deaths in the United States and exacting a profound personal and economic toll. Despite the increased resources that have recently been brought to bear to improve our understanding of TBI, the developme
This e-book will review special features of the cerebral circulation and how they contribute to the physiology of the brain. It describes structural and functional properties of the cerebral circulation that are unique to the brain, an organ with high metabolic demands and the need for tight water and ion homeostasis. Autoregulation is pronounced in the brain, with myogenic, metabolic and neurogenic mechanisms contributing to maintain relatively constant blood flow during both increases and decreases in pressure. In addition, unlike peripheral organs where the majority of vascular resistance resides in small arteries and arterioles, large extracranial and intracranial arteries contribute significantly to vascular resistance in the brain. The prominent role of large arteries in cerebrovascular resistance helps maintain blood flow and protect downstream vessels during changes in perfusion pressure. The cerebral endothelium is also unique in that its barrier properties are in some way more like epithelium than endothelium in the periphery. The cerebral endothelium, known as the blood-brain barrier, has specialized tight junctions that do not allow ions to pass freely and has very low hydraulic conductivity and transcellular transport. This special configuration modifies Starling's forces in the brain microcirculation such that ions retained in the vascular lumen oppose water movement due to hydrostatic pressure. Tight water regulation is necessary in the brain because it has limited capacity for expansion within the skull. Increased intracranial pressure due to vasogenic edema can cause severe neurologic complications and death.
Every few years a dissertation comes to the area of clinical application of medical technology which carries us forward as on a magic carpet into new regions of understanding and patient care. This book is such a magic carpet. It brings together, in a clear and incisive fashion, important hemodynamic principles with a simple noninvasive method of application to a part of the cerebral vasculature which has been relatively inaccessible. To the lucky and perceptive person who reads this book, a feeling of excitement and hope for progress is engendered. The diligent application of the potentials of transcranial Doppler ultrasound brings new power to our efforts in understanding the cerebral circulation and the causes, treatment and prevention of cerebrovascular disorders. Merrill P. Spencer, M. D. Director Institute of Applied Physiology and Medicine Seattle, Wash. , July 1986 Acknowledgements I am greatly indebted to Prof. He1ge Nornes, Oslo, who introduced me to the fascinating study of cerebral hemodynamics in the early 1970's and since then continually encouraged my interest in this field. It was through his pioneering work on the cerebral circulation-using peroperative electromagnetic flowmetry and Doppler techniques-that the basis was laid for the noninvasive trans cranial approach to the circle of Willis described in this book. I also gratefully acknowledge the stimulating case discussions with Prof. Peter Huber, Berne, at the very early introduction of trans cranial Doppler, the inspiring exchange of ideas with Dr. Merrill P.
This reference is a comprehensive work in the field of neurotrauma and critical care. It incorporates the fields of head injury, spinal injury and basic neurotrauma research into one source. The major emphasis is on the treatment of patients with head and spinal cord injury, including the management of all other problems that bear upon the care of these patients.
New and groundbreaking therapeutic options for the critical care of patients with cerebrovascular disease have improved patient management, minimized morbidity, reduced in-patient care, improved quality of life, and had a positive economic impact on health service provision. This volume integrates these approaches and suggests the best therapy option for all cerebrovascular conditions. The early chapters of the book focus on monitoring techniques and interventions. Subsequent sections address the critical care of a wide range of cerebrovascular diseases: ischemic stroke, intracranial hemorrhage, subarachnoid hemorrhage, arteriovenous malformations, cerebral venous thrombosis and traumatic injury. The editors and authors are internationally recognized experts in their field, and the text is supplemented by tables and illustrations to demonstrate important clinical findings. This book will meet the needs of stroke physicians, neurologists, neurosurgeons, neurointensivists and interventional neuroradiologists seeking to maximize positive outcomes for their patients.
The partition of fluid between the vascular and interstitial compartments is regulated by forces (hydrostatic and oncotic) operating across the microvascular walls and the surface areas of permeable structures comprising the endothelial barrier to fluid and solute exchange, as well as within the extracellular matrix and lymphatics. In addition to its role in the regulation of vascular volume, transcapillary fluid filtration also allows for continuous turnover of water bathing tissue cells, providing the medium for diffusional flux of oxygen and nutrients required for cellular metabolism and removal of metabolic byproducts. Transendothelial volume flow has also been shown to influence vascular smooth muscle tone in arterioles, hydraulic conductivity in capillaries, and neutrophil transmigration across postcapillary venules, while the flow of this filtrate through the interstitial spaces functions to modify the activities of parenchymal, resident tissue, and metastasizing tumor cells. Likewise, the flow of lymph, which is driven by capillary filtration, is important for the transport of immune and tumor cells, antigen delivery to lymph nodes, and for return of filtered fluid and extravasated proteins to the blood. Given this background, the aims of this treatise are to summarize our current understanding of the factors involved in the regulation of transcapillary fluid movement, how fluid movements across the endothelial barrier and through the interstitium and lymphatic vessels influence cell function and behavior, and the pathophysiology of edema formation. Table of Contents: Fluid Movement Across the Endothelial Barrier / The Interstitium / The Lymphatic Vasculature / Pathophysiology of Edema Formation
This book focuses on subarachnoid hemorrhage (SAH), describing in detail the neurophysiology, anatomy, epidemiology, grading, anesthesia management, coiling and interventional treatment of this dangerous disease. Written by leading international experts, it highlights the state-of-the-art techniques for the diagnosis and treatment (non-surgical and surgical) of SAH and the clinical variations. It also examines the reliability of the new techniques versus the standard clinical methods to predict problems related to SAH and its recent diagnosis and management. The book starts with a brief discussion of the epidemiology of SAH, cerebral circulation, anatomy of brain blood vessels and neurophysiology related to this fatal disease. Then, in the following chapters it covers grading of subarachnoid hemorrhage, anesthesia management of SAH, treatment, subarachnoid hemorrhage coiling and radiological intervention. Lastly, it explores surgical treatment of intracranial aneurysms in more detail, and addresses complications, critical care management and headache in SAH, traumatic SAH and prognosis. Featuring numerous images, tables, schema, illustrations and videos, the book is intended for junior and senior anesthesiologists, neuroscientists, intervention radiologists, intensivists and neurosurgeons.
The standard text and reference on neurological and neurosurgical intensive care is now in its Fourth Edition–thoroughly revised to incorporate the latest therapeutic advances and insights from the most recent clinical trials. A team of distinguished neuro-intensivists offers practical, state-of-the-art guidelines for managing the wide range of problems arising in postoperative neurosurgical care and care of patients with acute neurological diseases. This edition focuses sharply on the details of therapeutics. The authors, from leading neuro-intensive care units, have written the book collectively, giving it more cohesiveness and more of an authoritative consensus voice than previous multiauthored editions.
This volume provides an overview of new concepts in neurovascular interventions based on clinical and scientific knowledge of cerebrovascular disorders. It especially focuses on subarachnoid hemorrhage and cerebrovascular malformations, e.g. aneurysms, arterio-venous malformations, and cavernomas. A separate part addresses cerebral revascularization for both complex aneurysms and ischemia. All contributions were written by recognized experts and cover original papers presented at the 7th European Japanese Stroke Surgery Conference, held in Verona, Italy in June 2014. The authors present new trends and strategies for managing emerging problems, as well as in-depth discussions on controversial issues in the field.
