Relationship between chronic raised intracranial pressure and empty sella presenting hormonal disturbances

The role of intracranial pressure in the development and maintenance of the primary empty sella has been pointed out in the literature previously. The hormonal changes and clinical features have been evaluated in a 30 year-old female patient examined for a convexity meningioma and a 20 year-old patient examined for chronic hydrocephalus caused by cured meningitis. Histories and investigations revealed an empty sella turcica associated with primary amenorrhoea and delayed puberty. The removal of the convexity meningioma resulted in loss of amenorrhoea and a rise in plasma gonadotrophins. The establishment of a ventriculo-peritoneal shunt did not bring about any changes in hormonal values and clinical features except the subjective headache disappeared. The importance of consideration of intracranial causes in patients who have delayed puberty or absence of menstrual history is briefly emphasized in light of the literature. Our data also demonstrated a correlation between an increase in intracranial pressure and a deficiency of hormonal secretion by the hypophysis.     

The empty sella and pituitary adenomas

In 44 consecutive patients with sellar volume larger than 1100 mm³, computer tomography showed that 20 had an empty or partly empty sella. None had radiological evidence of a suprasellar tumor. 10 of the 20 patients had experienced episodes with acute neurological symptoms presumably reflecting a pituitary apoplexy. It is suggested that an unknown proportion of intrasellar adenomas may disappear as a result of an infarction, which may comprise the entire adenoma or part of it - leaving an empty or partly empty sella as diagnosed by computer tomography. Air encephalography will demonstrate the empty sella only if the diaphragmatic aperture is large enough to allow cisternal herniation. The infarction may present clinically with no, slight or severe acute neurological symptoms. Late consequences of a pituitary adenoma infarction may be rhinorrhea or hydrocephalus.     

Neurological outcome following neonatal post-haemorrhagic hydrocephalus: the effects of maximum raised intracranial pressure and ventriculo-peritoneal shunting

The neuromotor outcome of 33 survivors of grade 3 or 4 neonatal post-haemorrhagic hydrocephalus born between 1975 and 1988 was assessed at a mean age of 4.7 years (9 months to 13 years). Two outcomes were determined: 12 patients were either normal (10) or had neurological signs without functional impairments (2), while 21/33 were moderately (16), severely (2), or profoundly impaired (3). Intracranial pressure (ICP) was measured in 26/33 patients (4–40 mm Hg): 2 had normal pressures (<5.6 mm Hg) and were normal. Raised ICP was not significantly different between outcome groups. Twenty-seven children were shunted; 10/27 had five or more operations (up to 14) and all of these had abnormal neurological outcomes, whereas the number of children with 1–4 shunt procedures was equal in both outcome groups. The rise in morbidity after the fourth shunt procedure may be associated with the ventriculitis suffered by 9 of the 10 patients with more than four shunts (P<0.01): this compares with 4/14 cases of ventriculitis in the children with 2–4 shunts and no cases of infection in the 3/27 who were shunted once. Outcome was independent of antenatal and perinatal factors including the age at or mode of presentation, and was unrelated to grade of intraventricular haemorrhage or parenchymal changes on ultrasound or CT scanning. Conclusion: for these small numbers, adverse outcome is statistically related to more than four shunt procedures and ventriculitis but independent of maximum ICP or other perinatal factors.     

颅内高压状态下TCD频谱参数与颅内压关系的实验研究

目的 探讨颅高压状态下经颅多普勒超声(TCD)频谱参数与颅内斥(ICP)的关系。方法 制备新西兰兔球囊注水法颅高压模型，监测大脑中动脉的TCD频谱，测量参数?结果 TCD频谱参数cf、PI、RI、Vd、Vm与ICP均呈指数关系，其中cf与ICP的相关系数最大。结论 TCD频谱参数与颅内压的升高密切相关。     

颅内脑膜瘤病理学性质与其发生部位的关系

目的探讨颅内脑膜瘤的病理学性质与其发生部位之间的关系。方法我院自2010年1月至2012年12月手术切除经病理学证实的452例脑膜瘤,回顾性分析这些病例的临床资料,分析颅内脑膜瘤发生部位和病理学性质之间的关系。结果脑膜内皮型脑膜瘤主要见于嗅沟（63%,26/41）和蝶骨嵴（50%,23/46）;间变型脑膜瘤主要见于中颅窝底（56%,10/18）;大脑凸面、矢状窦旁和小脑幕以纤维型脑膜瘤较多,分别占24%（27/113）、36%（24/67）和38%（20/52）。脑膜内皮型（49%,75/153）和间变型（6.5%,10/53）脑膜瘤更常见于颅底（包括蝶骨嵴、桥小脑角、中颅窝底、嗅沟、鞍部、枕骨大孔和斜坡）,而纤维型（26.3%,51/180）脑膜瘤常见于颅盖部（包括大脑凸面和矢状窦旁）。结论颅内脑膜瘤的发生与其原发部位可能存在某种关联,不同的部位有发生不同病理学性质脑膜瘤的倾向。     

去骨瓣减压术后经颅多普勒参数与颅内压相关性研究

目的探讨去骨瓣减压术后经颅多普勒(TCD)参数与颅内压(ICP)相关性及临床意义。方法应用TCD检测52例去骨瓣减压术后次日患者的双侧脑血流,并与即时ICP进行相关性分析。结果①随着ICP的变化,TCD频谱图像表现为高阻波形,参数平均血流速度(Vm)呈下降趋势,搏动指数(PI)呈上升趋势;②健侧与患侧TCD参数不同,具有统计学差异(P<0.01)。结论去骨瓣减压术后次日TCD参数与ICP存在密切相关性,TCD结果提示颅内存在压力差,初步阐明无创TCD在神经外科急症术后监测中发挥重要的作用。     

成人头颅骨模型模拟去骨瓣减压术后颅内压变化

目的 了解去骨瓣减压术对颅内压及颅腔顺应性的影响。方法 以正常成年男性尸头颅数据制作一个密闭颅腔模型及颅内压研究模型,按骨瓣位置、初始颅内压及骨瓣面积分组,测定模拟去骨瓣减压术前后压力,分析骨瓣面积与降压效果的关系。结果 颅内压升高至30 mmHg以上,随着骨瓣面积增大可逐渐降至基础压力,降压效果与骨瓣面积呈正相关（r=0.99,95% CI 0.98~0.99;P<0.001）。两者线性回归方程为y=81.07+0.79b（y为代偿容积,b为骨瓣面积）,截距a 95% CI:77.78~84.36（P<0.001）,回归系数b 95% CI 0.73~0.85（P<0.001）;决定系数R2=0.99。结论 去骨瓣减压术能迅速有效降低颅内压,降压效果与骨瓣面积正相关。     

颅脑创伤患者颅内压相关参数与预后关系的研究

目的 探讨颅脑创伤患者的颅内压（ICP）相关参数与预后的关系.方法 回顾性纳入2016年11月至2017年10月上海交通大学医学院附属仁济医院神经外科重症监护室收治的50例闭合性颅脑创伤患者.患者均行有创颅内压、动脉压监测,采用Neumatic DCR数据采集系统监测ICP相关参数.根据出院时格拉斯哥预后分级（GOS）将患者分为预后不良组（GOS Ⅰ、Ⅱ级）20例和预后相对良好组（GOSⅢ-Ⅴ级）30例.比较两组患者的ICP相关参数,采用受试者工作特征曲线（ROC）评估相关参数的预测能力.结果 （1）与预后相对良好组比较,预后不良组的ICP[（26.2±13.4）mmHg对比（14.0±5.6） mmHg]、压力反应指数（PRx,0.48±0.21对比0.12 ±0.08）及ICP波幅与动脉压波幅的相关系数（IAAC,中位数为0.14对比0.01）均升高,平均脑灌注压[CPP,（48.9±19.9） mmHg对比（81.1±6.9）mmHg]降低,差异均有统计学意义（均P〈0.01）;ICP波幅与ICP的相关系数（RAP）差异无统计学意义（P〉0.05）.多因素二元Logistic回归分析显示,ICP（OR=2.187,95％ CI：1.079-4.431,P=0.031）、PRx（OR=21.608,95％ CI：3.012-155.014,P=0.002）是预后的独立影响因素.（2）预后不良组在20 mmHg及22 mmHg阈值上的ICP“剂量”（DICP20、DICP22）均高于预后相对良好组（均P〈0.05）.DICP20的ROC曲线下面积为0.70,DICP22为0.71.预后不良组在0.25及0.05阈值上的PRx“剂量”（D PRx0.25、DPRx0.05）均高于预后相对良好组;DPRx0.25的曲线下面积为0.97,DPRx0.05为0.96.结论 ICP和PRx为颅脑创伤患者不良预后的独立危险因素;ICP“剂量”和PRx“剂量”均可作为判断患者死亡及植物状态预后的参数,且PRx“剂量”的准确性更高.     

Lack of relationship between resistance to cerebrospinal fluid outflow and intracranial pressure in normal pressure hydrocephalus

OBJECTIVE: To explore whether calculation of resistance to cerebrospinal fluid (CSF) outflow (Rout) by the lumbar constant rate infusion test in a reliable way predicts the intracranial pressure (ICP) profile in normal pressure hydrocephalus (NPH). METHODS: A prospective study was undertaken including 16 cases with clinical signs of normal pressure hydrocephalus that were investigated with both continuous ICP monitoring and the lumbar constant rate infusion test. Intracranial pressure monitoring was performed for about 24 h, and supplied with a simultaneous lumbar constant rate infusion test at the end of the monitoring period. The pressure recordings were analysed using the Sensometrics Pressure Analyser. Various characteristics of the pressure curves were compared. RESULTS: The continuous ICP recordings were considered as normal (mean ICP<11.5 mmHg) in all 16 cases. The lumbar infusion test showed an apparently abnormal resistance to CSF outflow (Rout) (> or =12.0 mmHg/ml/min) in 12 of 16 cases. There was no relationship between lumbar Rout and mean ICP during sleep. We could not find any relationship between lumbar Rout and number of nightly ICP elevations of 1525 mmHg lasting 0.5 or 1 min. Neither resistance to CSF outflow (Rout) nor mean ICP during sleep was related to the ventricular size. CONCLUSIONS: The results of this prospective study revealed no significant relationship between resistance to CSF outflow (Rout) and the ICP profile in NPH cases. The results also suggest that caution should be made when predicting the ICP profile on the basis of measuring the lumbar CSF pressure for a few minutes duration.     

Correlation between intracranial pressure (ICP) and changes in CT images of cerebral hemorrhage

Abstract

The relationship between intracranial pressure and CT images was investigated in 80 cases of cerebral hemorrhage that occurred between 1984 and 1990. In traumatic intracerebral hematoma, positive correlation was found between intracranial pressure and both shift of midline structures and volume of hematoma except in the occipital lobe or at the base of the frontal lobe. In nontraumatic intracerebral hematoma, increased intracranial pressure was found to correlate with changes in the configuration of the lateral ventricles, intraventricular hemorrhage, and compression of the basal cisterns and cortical sulci. No correlation between intracranial pressure and hematoma volume was observed, most likely due to the number of elderly patients in the subject population. In nontraumatic subarachnoid hemorrhage, positive correlation existed between increased intracranial pressure and intraventricular hemorrhage as well as Evans' ratio calculated using repeat CT images that were obtained due to disturbances in cerebrospinal fluid circulation. These results suggest that the degree by which intracranial pressure increases in patients with cerebral hemorrhage can be estimated by the changes in CT images. [Neural Res 1998; 20: 225-230]     

高血压患者夜间血压变化与颅内动脉粥样硬化狭窄的相关性

目的探讨高血压患者夜间血压变化与颅内动脉粥样硬化狭窄(ICAS)的相关性。方法对高血压患者进行动态血压监测和脑血管磁共振血管成像(MRA)检查。颅内大动脉内径狭窄程度≥50%定义为ICAS,ICAS病灶数≥2定义为多发性ICAS。根据日间与夜间平均血压水平,将昼夜血压变化分为杓型、非杓型、反杓型。结果共359例高血压患者进入本研究:ICAS患者135例,单发性ICAS 86例,多发性ICAS 49例;226例(63.0%)日间平均血压升高,322例(89.7%)夜间平均血压升高;杓型37例(10.3%),非杓型166例(46.2%),反杓型156例(43.5%)。多因素Logistic回归分析提示:日间平均血压升高、夜间平均血压升高、夜间血压非杓型改变、夜间血压反杓型改变均与ICAS无显著相关性(P0.05);夜间血压反杓型改变与多发性ICAS密切相关(P0.05)。结论夜间血压反杓型改变可能是多发性ICAS的独立危险因素。     

Relationship between anterior fontanelle pressure measurements and clinical signs in infantile hydrocephalus

The treatment of choice in progressive hydrocephalus is drainage of cerebrospinal fluid in order to reduce elevated intracranial pressure (ICP). Defining the right moment for surgical intervention, however, in a hydrocephalic infant on the basis of clinical signs alone can be a difficult task. Clinical signs of raised ICP are known to be unreliable and sometimes even misleading. In the present study, the relationship between long-term anterior fontanelle pressure (AFP) measurements and clinical signs was investigated in 37 infants with hydrocephalus. The decision as to whether to operate or not was based on clinical signs alone; AFP values were not taken into account. There was an overall difference between the non-operated group and the preoperative measurements in the operated group, and also between the preoperative and the postoperative measurements in the latter, in regard to both AFP measurements and clinical signs. Almost all preoperative AFP values were increased. The direct correlation () between most individual clinical signs and AFP levels, however, was low (=0.15–0.41). The clinical sign tense fontanelle showed the best correlation with the AFP levels (=0.75). Furthermore, using logistic regression analysis, no combination of clinical signs could be found which reliably predicted the AFP. The relationship between the AFP pressure variables and clinical signs was also examined. The pathological A-waves occurred only in the presence of raised (baseline) AFP, a situation in which considerably more frequent B-waves were observed as well. It was concluded that clinical signs of raised ICP in infantile hydrocephalus are not very reliable and AFP monitoring can therefore provide valuable information on intracranial dynamics in patients with dubious neurological manifestations of progressive hydrocephalus.     

重症颅脑损伤患者血清硫氧还蛋白1与颅内压改变的相关性

目的 监测重症颅脑损伤患者动态血清硫氧还蛋白1(TRX1)与颅内压(ICP)的变化情况,分析TRX1水平与ICP的相关性.方法 回顾性分析2019-01—2020-02濮阳市人民医院确诊并完成治疗的40例重症颅脑损伤患者的临床资料,将其纳入观察组,选取同期40例轻中型颅脑损伤患者纳入对照组,监测并记录2组患者颅脑损伤后...     

Discrepancies between brain CT imaging and severely raised intracranial pressure proven by ventriculostomy in adults with pneumococcal meningitis

Objectives: Computed tomography (CT) of the brain is recommended for assessment of intracranial pressure (ICP) of patients with acute bacterial meningitis who are comatose or show focal neurological deficits. The aim of this report is to draw attention to the possibility of a discrepancy between CT findings and ICP values in some patients with pneumococcal meningitis. Methods: We describe three adult patients with pneumococcal meningitis who had both successive CT examinations and ICP measurements at the time of clinically evident cerebral herniation (n = 2) and/or prolonged coma (n = 2). Results: Although measurements with a ventriculostomy catheter indicated that all three patients had severely raised ICP values of 90, 44, and 45 mmHg, repeated cranial CT greatly underestimated true ICP values. Despite clinical evidence of acute cerebral herniation, it was not detected in the contemporary CT findings of two patients. Continuous ICP monitoring in the ICU helped to guide treatment for increased ICP; nevertheless, two patients died. Conclusions: The clinician must be aware that cranial CT may fail to rule out the possibility of severely raised ICP or cerebral herniation in a patient with pneumococcal meningitis. Therefore, ICP monitoring of patients with bacterial (especially pneumococcal) meningitis who are in prolonged coma should be considered early and regardless of the cranial CT appearances. Received: 7 November 2001, Received in revised form: 8 April 2002, Accepted: 16 April 2002     

CT测量视神经鞘直径与急性颅脑创伤开颅术后颅内压的相关研究

目的探讨急性重型颅脑创伤患者开颅术后视神经鞘直径(ONSD)与颅内压(ICP)的相互关系,评价ONSD推测ICP变化情况的效能。方法回顾性分析48例急性重型颅脑创伤患者数据,通过重建头部薄层CT来测量球后ONSD,采用有创ICP传感器监测颅内压等临床数据;患者数据按手术类型分类为开颅手术组和单纯ICP组,分别应用线性及Logistic回归分析ONSD与ICP相关性及ONSD的评价效能。结果 48例患者平均ONSD=6.6mm(SD 0.5 4),平均ICP=12mmHg(SD6.5),ONSD与ICP呈明显线性相关性,其中手术组的线性关系更加明显,AUC=0.964,cutoff=7.1 mm,敏感性=100%,特异性=8 9%,P0.0 0 1,ONSD用于推测ICP效能较高,有统计学意义;而ICP组两者间无明显线性相关性。结论急性重症颅脑创伤开颅术后患者ONSD与ICP线性关系明显,可通过ONSD是否大于7.1 mm来推测ICP20 mm Hg,为危急重症患者提供重要的参考意见。     

Relationship between chronic hyperglycemia and contrast extravasation in revascularization of symptomatic intracranial atherosclerotic stenosis: A retrospective single-center study

Background and purposeContrast extravasation is one of the most common perioperative complications in symptomatic intracranial atherosclerotic stenosis (ICAS) patients after percutaneous transluminal angioplasty and/or stenting (PTAS). This study aimed to investigate the correlations between the relevant serum biochemical indicators of carbohydrate metabolism and the occurrence of contrast extravasation.MethodsPatients’ demographic characteristics, vascular risk factors and laboratory examination data were collected. Blood routine test, blood biochemical examination and hormone level test within 1 week before surgery were measured in all enrolled subjects. Patients underwent non-contrast CT scans immediately after the endovascular procedure. Follow-up non-contrast CT scans were performed in the next 24 h and repeated as per clinical condition.Results104 patients who have undergone effective PTAS were involved in this study. 18 patients have identified as contrast extravasation and there was no obvious abnormality in another 86 cases. There were significant differences in the pre-operative HbA1c, fasting blood sugar and cortisol levels in the subjects regardless of gender between two groups (p < 0.001, p < 0.001 and p = 0.001, respectively). Furthermore, there were statistical differences in E2 and testosterone levels between two groups in both male population (p = 0.035 and p = 0.028, respectively) and female population (p = 0.036 and p = 0.003, respectively). Besides, the AUC value of HbA1c, fasting blood sugar and cortisol levels were all over 0.7 (0.858, 0.780 and 0.752, respectively). The highest AUC value of various combinations was obtained from the combination of HbA1c and cortisol level, which was 0.898.ConclusionsPatient with chronic hyperglycemia is closely related to contrast extravasation after PTAS. Specific mechanisms might be explored and regarded as promising candidates to prevent contrast extravasation.