BACKGROUND: Understanding the risk factors leading to intracranial aneurysm (IA) rupture have still not been fully clarified. They are vital for proper medical guidance of patients harboring unruptured IAs. Clarifying the hemodynamics associated with the point of rupture could help could provide useful information about some of the risk factors. Thus far, few studies have studied this issue with often diverging conclusions. METHODS: We identified a point of rupture in patients operated for an IAs during surgery, using a combination of preoperative computed tomography (CT) and computed tomography angiography (CTA). Hemodynamic parameters were calculated both for the aneurysm sac as a whole and the point of rupture. In two cases, the results of CFD were compared with those of the experiment using particle image velocimetry (PIV). RESULTS: We were able to identify 6 aneurysms with a well-demarcated point of rupture. In four aneurysms, the rupture point was near the vortex with low wall shear stress (WSS) and high oscillatory shear index (OSI). In one case, the rupture point was in the flow jet with high WSS. In the last case, the rupture point was in the significant bleb and no specific hemodynamic parameters were found. The CFD results were verified in the PIV part of the study. CONCLUSION: Our study shows that different hemodynamic scenarios are associated with the site of IA rupture. The numerical simulations were confirmed by laboratory models. This study further supports the hypothesis that various pathological pathways may lead to aneurysm wall damage resulting in its rupture.
- Publikační typ
- časopisecké články MeSH
Nízkotlaký hydrocefalus (low-pressure hydrocephalus; LPH) představuje závažné onemocnění, které je charakterizováno dilatací komorového systému a klinickými příznaky intrakraniální hypertenze, přestože tlak likvoru v mozkových komorách je pod normálními hodnotami. Patofyziologie LPH zůstává komplexní a stále ne zcela objasněná, ale zdá se, že souhra mechanizmů zahrnující izolaci komorového systému od subarachnoideálního prostoru, změny elasticity, kompliance a permeability mozkové tkáně a zvýšenou permeabilitu mozkové tkáně může hrát klíčovou roli. Diagnóza LPH by měla být zvážena u pacientů s klinickými příznaky intrakraniální hypertenze a dilatací komorového systému na zobrazovacích metodách, při zachované patentní drenáži likvoru a normálním nastavení tlaku. Léčba LPH zahrnuje dočasnou léčbu zajišťující stabilizaci pacienta pomocí zevní komorové drenáže a postupné odvykání od drenáže za pomoci zvyšování intrakraniálního tlaku. Trvalou léčbu představuje endoskopická stomie třetí komory a implantace shuntu s nízkým nastavením diferenčního tlaku. Volba typu shuntu může být individuální, nedoporučuje se pouze typ lumbo-peritoneální. Je třeba zdůraznit, že rozpoznání a řádná léčba LPH jsou klíčové, neboť nesprávná léčba může vést k fatálním následkům. Navzdory přetrvávajícím výzvám v diagnostice a léčbě LPH je důležité, aby bylo toto onemocnění odborné veřejnosti dobře známé.
Low-pressure hydrocephalus (LPH) is a serious disease characterized by ventricular dilatation and clinical signs of intracranial hypertension, although the pressure of the cerebrospinal fluid (CSF) in the cerebral ventricles is below the normal range. The pathophysiology of LPH remains complex and not fully understood, but it seems that a combination of mechanisms involving isolation of the ventricular system from the subarachnoid space, changes in brain tissue elasticity and compliance, and increased brain tissue permeability may play a key role. The diagnosis of LPH should be considered in patients with clinical signs of intracranial hypertension and ventricular dilatation on imaging with preserved patent CSF drainage and normal pressure settings. Treatment of LPH includes temporary therapy to ensure patient stabilization with external ventricular drainage and gradual weaning from drainage with the use of increasing intracranial pressure. Permanent treatment includes endoscopic ventriculostomy of the third ventricle and implantation of a shunt with a low differential pressure setting. The choice of the type of shunt may be individualized; only the lumbo-peritoneal type is not recommended. It should be emphasized that recognition and proper treatment of LPH are crucial, as improper treatment can lead to fatal consequences. Despite the ongoing challenges in the diagnosis and treatment of LPH, it is important that the disease is well known to the professional community.
- Klíčová slova
- nízkotlaký hydrocefalus, zevní komorová drenáž,
- MeSH
- hydrocefalus * diagnóza patofyziologie terapie MeSH
- lidé MeSH
- shunty pro odvod mozkomíšního moku metody MeSH
- ventrikulostomie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Cíl: Cílem práce je detailní popis anatomie arteria recurrens Heubneri a zjištění četnosti ischemie v jejím povodí po klipu aneuryzmat arteria communicans anterior. Soubor a metodika: Byla provedena laboratorní mikroskopická disekce arteria recurrens Heubneri a rešerše literatury s popisem jejích variet. V klinické části byly vyhodnoceny snímky CT mozku po operaci 215 aneuryzmat arteria communicans anterior ošetřených klipem na Neurochirurgické klinice v Ústí nad Labem v období 2006–2022. Výsledky: Bylo dokumentováno zdvojení arteria recurrens Heubneri, vyskytující se jen ve 14 % případů, a její extracerebrální anastomóza s perforátory arteria cerebri media, vyskytující se pouze v 10 % případů. V klinické části byla zjištěna četnost ischemie v povodí arteria recurrens Heubneri po operaci aneuryzmat arteria communicans anterior ve 14,4 %, u krvácejících aneuryzmat v 19,6 % a u asymptomatických aneuryzmat v 6 %. Závěr: Arteria recurrens Heubneri je jednou z tepen, jejíž precizní anatomická znalost minimalizuje riziko komplikací při provádění vaskulárních i neuroonkologických operací v oblasti jejího průběhu.
Aim: The work aims to describe in detail the anatomy of the recurrent artery of Heubner and determine the frequency of ischemia in its territory after clipping of aneurysms of the arteria communicans anterior. Sample and methodology: We performed a laboratory microscopic dissection of the recurrent artery of Heubner as well as literature research of a description of its varieties. In the clinical part, we evaluated post-operative brain CT images of 215 aneurysms of the anterior communicating artery treated with clipping at the Department of Neurosurgery in Ústí nad Labem between 2006–2022. Results: We documented duplication of the arteria recurrens Heubneri, occurring only in 14% of cases, and its extracerebral anastomosis with perforators of the middle cerebral artery, occurring only in 10% of cases. In the clinical part, the frequency of ischemia in the Heubneri recurrent artery territory after surgery for anterior communicating artery aneurysms was found to be 14.4%, for bleeding aneurysms it was 19.6% of cases, and for asymptomatic aneurysms it was of 6% cases. Conclusion: Arteria recurrens Heubneri is one of the arteries which precise anatomical knowledge minimizes the risk of complications when performing vascular and neuro-oncological operations in the area of its course.
- MeSH
- arteria cerebri anterior * patologie MeSH
- arteriae cerebrales chirurgie patologie MeSH
- intrakraniální aneurysma chirurgie komplikace MeSH
- ischemie mozku MeSH
- lidé MeSH
- nemoci cerebrálních arterií chirurgie diagnóza MeSH
- neurochirurgické výkony metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
Laboratory analysis of basic cerebrospinal fluid (CSF) parameters is considered as essential for any CSF evaluation. It can provide rapidly very valuable information about the status of the central nervous system (CNS). Our retrospective study evaluated parameters of basic CSF analysis in cases of either infectious or non-infectious CNS involvement. Neutrophils are effector cells of innate immunity. Predominance of neutrophils was found in 98.2% of patients with purulent inflammation in CNS. Lymphocytes are cellular substrate of adaptive immunity. We found their predominance in 94.8% of patients with multiple sclerosis (MS), 66.7% of patients with tick-borne encephalitis (TBE), 92.2% of patients with neuroborreliosis, 83.3% of patients with inflammatory response with oxidative burst of macrophages in CNS and 75.0% of patients with malignant infiltration of meninges (MIM). The simultaneous assessment of aerobic and anaerobic metabolism in CSF using the coefficient of energy balance (KEB) allows us to specify the type of inflammation in CNS. We found predominantly aerobic metabolism (KEB > 28.0) in 100.0% CSF of patients with normal CSF findings and in 92.8% CSF of patients with MS. Predominant faintly anaerobic metabolism (28.0 > KEB > 20.0) in CSF was found in 71.8% patients with TBE and in 64.7% patients with neuroborreliosis. Strong anaerobic metabolism (KEB < 10.0) was found in the CSF of 99.1% patients with purulent inflammation, 100.0% patients with inflammatory response with oxidative burst of macrophages and in 80.6% patients with MIM. Joint evaluation of basic CSF parameters provides sufficient information about the immune response in the CSF compartment for rapid and reliable diagnosis of CNS involvement.
- Publikační typ
- časopisecké články MeSH
Spontánní intrakraniální hypotenze (SIH) je onemocnění, jehož hlavním příznakem je bolest hlavy. V posledních letech zaujala důležité místo v široké diferenciální diagnostice příčin tohoto symptomu. Přispívají k tomu také pokroky, kterých bylo dosaženo při pochopení patofyziologie, zpřesnění diagnostiky a rozšíření terapeutických možností tohoto onemocnění. SIH často postihuje mladé pacienty v produktivním věku a může vést k významnému narušení jejich sociálního i pracovního života. Její rozpoznání a správná léčba tak mají jistě velký význam. V tomto referátu přehledně shrnujeme pohled na patogenezi SIH, současné postupy a doporučení v diagnostice a terapii této nemoci, podpořené typickou kazuistikou, jejíž popis je dostupný v online verzi tohoto referátu..
Spontaneous intracranial hypotension (SIH) is a disease in which headache is the main symptom. Recently, it has become an important part of the broad differential diagnosis of causes of headache. Advances in understanding of pathophysiology, indication of proper imaging modalities, and expansion of microsurgical techniques contributed to increased recognition of the disease. Young patients in productive age commonly suffer from SIH, and it might negatively influence both their social and professional life. Therefore, it is of great importance to recognize the symptoms of the disease and treat it properly. The aim of our article is to provide a review of the pathogenesis, current recommendations for the diagnosis and therapy of SIH. A report of a typical case should support our effort.
- Klíčová slova
- průsak mozkomíšního moku, epidurální krevní zátka,
- MeSH
- bolesti hlavy etiologie terapie MeSH
- intrakraniální hypotenze * diagnóza patofyziologie terapie MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
The simultaneous cytological and metabolic investigation of various extravascular body fluids (EBFs) provides clinically relevant information about the type and intensity of the immune response in particular organ systems. The oxidative burst of professional phagocytes with the concomitant production of reactive oxygen species consumes a large amount of oxygen and is the cause of switch to the development of anaerobic metabolism. We assessed the relationships between percentages of neutrophils, aerobic and anaerobic metabolism, and tissue damage via the determination of aspartate aminotransferase catalytic activities (AST) in cerebrospinal fluid (CSF), pleural effusions (PE), abdominal effusions (AE), and synovial fluids (SF). EBFs with 0.0-20.0% neutrophils: 83.0% aerobic and 1.3% strongly anaerobic cases with median of AST = 13.8 IU/L in CSF; 68.0% aerobic and 9.0% strongly anaerobic cases with median of AST = 20.4 IU/L in PE; 77.5% aerobic and 10.5% strongly anaerobic cases with median of AST = 18.0 IU/L in AE; 64.1% aerobic and 7.7% strongly anaerobic cases with median of AST = 13.8 IU/L in SF. EBFs with 80.0-100.0% neutrophils: 4.2% aerobic and 73.7% strongly anaerobic cases with median of AST = 19.2 IU/L in CSF; 7.4% aerobic and 77.3% strongly anaerobic cases with median of AST = 145.2 IU/L in PE; 11.8% aerobic and 73.7% strongly anaerobic cases with median of AST = 61.8 IU/L in AE; 25.5% aerobic and 38.2% strongly anaerobic cases with median of AST = 37.2 IU/L in SF. The significant presence of neutrophils, concomitant strong anaerobic metabolism, and elevated AST in various EBFs are reliable signs of damaging purulent inflammation.
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
Extravasation of blood in the central nervous system (CNS) represents a very strong damaged associated molecular patterns (DAMP) which is followed by rapid inflammation and can participate in worse outcome of patients. We analyzed cerebrospinal fluid (CSF) from 139 patients after the CNS hemorrhage. We compared 109 survivors (Glasgow Outcome Score (GOS) 5-3) and 30 patients with poor outcomes (GOS 2-1). Statistical evaluations were performed using the Wilcoxon signed-rank test and the Mann-Whitney U test. Almost the same numbers of erythrocytes in both subgroups appeared in days 0-3 (p = 0.927) and a significant increase in patients with GOS 2-1 in days 7-10 after the hemorrhage (p = 0.004) revealed persistence of extravascular blood in the CNS as an adverse factor. We assess 43.3% of patients with GOS 2-1 and only 27.5% of patients with GOS 5-3 with low values of the coefficient of energy balance (KEB < 15.0) in days 0-3 after the hemorrhage as a trend to immediate intensive inflammation in the CNS of patients with poor outcomes. We consider significantly higher concentration of total protein of patients with GOS 2-1 in days 0-3 after hemorrhage (p = 0.008) as the evidence of immediate simultaneously manifested intensive inflammation, swelling of the brain and elevation of intracranial pressure.
- Publikační typ
- časopisecké články MeSH
Brain ischemia after central nervous system (CNS) bleeding significantly influences the final outcome of patients. Catalytic activities of aspartate aminotransferase (AST) in the cerebrospinal fluid (CSF) to detect brain ischemia were determined in this study. The principal aim of our study was to compare the dynamics of AST in 1956 CSF samples collected from 215 patients within a 3-week period after CNS hemorrhage. We compared concentrations of the AST catalytic activities in the CSF of two patient groups: survivors (Glasgow Outcome Score (GOS) 5-3) and patients in a vegetative state or dead (GOS 2-1). All statistical evaluations were performed using mixed models and the F-test adjusted by Kenward and Roger and the Bonferroni adjustment for multiple tests. The significantly higher catalytic activities of AST in the CSF from patients with the GOS of 2-1 when compared to those who survived (GOS 5-3, p = 0.001) were found immediately after CNS haemorrhage. In the further course of time, the difference even increased (p < 0.001). This study confirmed the key association between early signs of brain damage evidenced as an elevated AST activity and the prediction of the final patient's clinical outcome. The study showed that the level of AST in the CSF could be the relevant diagnostic biomarker of the presence and intensity of brain tissue damage.
- Publikační typ
- časopisecké články MeSH
