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Hyper flow and intracranial hypertension in diffuse axonal injury: An update to gennarelli doctrine

  • Conference paper
Reconstructive Neurosurgery

Part of the book series: Acta Neurochirurgica Supplementum ((NEUROCHIRURGICA,volume 101))

Abstract

Twelve consecutive paediatric (six) and adult (six) patients harbouring a neuroradiological pattern consistent with diffuse axonal injury (DAI) along with slit ventricles underwent haemodynamic study in the Intensive Care Unit of our University. All the patients had GCS scores less than 8 after a severe brain injury, serial head computed tomography (CT) and magnetic resonance (MR) scans demonstrated a radiological pattern of DAI. Transcranial Doppier Sonography (TCD) of the middle cerebral arteries was performed through the temporal bone window in all the patients. All patients but one underwent a continuous monitoring of intracranial pressure (ICP) and cerebral extraction of O2 (CEO2). Therapy with barbiturates and hyperventilation was necessary in all the cases. In two patients (one adult and one paediatric) a bilateral decompressive craniectomy was performed in order to decrease a severe intracranial hypertension. Hyperflow along with intracranial hypertension, variably responsive to barbiturate therapy, was observed in all the patients by means of TCD and CEO2. In our patients intracranial hypertension along with hyperflow syndrome were found associated with DAI. Medical as well as surgical treatments were tailored according to the haemodynamic study.

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Author information

Authors and Affiliations

  1. Institute of Neurosurgery, Catholic University Medical School, Rome, Italy

    Massimiliano Visocchi M.D.

  2. Institute of Neurosurgery, Université Cattolica del S. Cuore, Lgo. A. Gemelli 8, 00168, Rome, Italy

    Massimiliano Visocchi M.D.

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  1. Massimiliano Visocchi M.D.
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Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, R.O.C.

    Wen-Ta Chiu

  2. Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan, R.O.C.

    Yung-Hsiao Chiang

  3. Department of Neurosurgery, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan, R.O.C.

    Ming-Chien Kao  & Ching-Chang Hung  & 

  4. Center for Neuropsychiatry, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C.

    Shinn-Zong Lin

  5. Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan, R.O.C.

    Han-Jung Chen

  6. Department of Rehabilitation Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan, R.O.C.

    Simon F. T. Tang

  7. National Institute on Drug Abuse, National Institute of Health, Baltimore, USA

    Barry J. Hoffer

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© 2008 Springer-Verlag

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Visocchi, M. (2008). Hyper flow and intracranial hypertension in diffuse axonal injury: An update to gennarelli doctrine. In: Chiu, WT., et al. Reconstructive Neurosurgery. Acta Neurochirurgica Supplementum, vol 101. Springer, Vienna. https://doi.org/10.1007/978-3-211-78205-7_23

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  • DOI: https://doi.org/10.1007/978-3-211-78205-7_23

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-78204-0

  • Online ISBN: 978-3-211-78205-7

  • eBook Packages: MedicineMedicine (R0)

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