Patients with a brain injury must overcome a central neurological insult and a systematic metabolic response. The systematic response includes hypermetabolism, hypercatabolism, altered vascular permeability, increased hormone and cytokine release, altered gastric emptying, altered mineral metabolism and altered immune status. This response may initiate mechanisms which lead to secondary brain injury and may adversely affect the function of other organs. Last two decades have improved our knowledge of pathophysiology in patients with primary and secondary brain injury including traumatic contusions. In a moment of injury, primary brain injury which is traumatic contusion can not be therapeutically prevented it can only have a preventive effect. Secondary brain injury can be therapeutically affected although both types of injuries have common pathophysiological signs of disturbed metabolism on cells and subcellular level. Research methods based on molecular biology opens a new zone of research reaction of central neurological system for trauma or ischemia with effort to get involved immediately at the beginning of developing adverse pathophysiological cascade leading to a death of neurotic cell. The brain contusion is a primary centre of brain injury with anatomic changes which can be graphically proved. In...

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There has been much discussion about the relationship between hormonal contraceptives and the development of pseudotumor cerebri (PTC). Some have claimed that progestin-containing contraceptives, such as levonorgestrel intrauterine devices, are linked to PTC. However, the relationship and mechanism of PTC following the use of progestin-containing contraceptives remain controversial. We present a case of PTC following implantation of Nexplanon® (etonogestrel) (Merck Sharp & Dohme BV, Haarlem, The Netherlands), a progestin contraceptive. Clinicians should be vigilant for visual disturbances, headache, nausea, and other signs of increased intracranial pressure in patients receiving progestin-containing contraceptives.

Primary angiitis of the central nervous system (PACNS) is a rare form of vasculitis. It is a diagnosis of exclusion and often diagnosed post mortem on pathologic evaluation. Cerebral angiography can be suggestive, but biopsy is required. Symptoms can vary from headache to focal cranial nerve deficits. On the more severe spectrum, patients can present with ischemic and vary rarely hemorrhagic stroke. We present in this case report key clinical pearls regarding suspected diagnosis. Younger patients with cortical hemorrhages may have PACNS instead of the more common cerebral amyloid angiopathy. Early suspicion may aid in initiating effective treatment as we highlight in the discussion.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24966号 / 医博第5020号 / 新制||医||1069(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 江木 盛時, 教授 浅野 雅秀, 教授 湊谷 謙司 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24789号 / 医博第4981号 / 新制||医||1066(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 江木 盛時, 教授 湊谷 謙司, 教授 花川 隆 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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Nonfatal strangulation (NFS) can cause severe physical and psychological injury. Instances of NFS are correlated with a heightened risk of lethal violence between partners [1]. While NFS does not result in death, it can result in severe hypoxic brain injury (HBI) and has been shown to increase the likelihood of an eventual fatality in the relationship eightfold [1]. Unfortunately, minimal quantitative biomechanical research has been performed to study strangulation injury, and detection and diagnosis of NFS, which often relies upon visible injuries, remains challenging [2]. The effects of occluded cerebral venous flow on intracranial pressure (ICP) have not been considered in a model for HBI as opposed to the context of stroke and neonatal hypoxic-ischemic encephalopathy. In this project, the effects of elevated ICP on the hemodynamics and structural dynamics of a diploic vein were considered. This was done by performing transient coupled fluid-structure simulations on a segment of an intracranial vein that sought to replicate the ICP surge experienced during strangulation. The vessel model was created by isolating a segment of an intracranial vessel. Using the software 3D Slicer, the skull was extracted and exported as an STL file. From there, a segment of a diploic vein was isolated and edited by importing the STL into Blender. The segment was then processed using MeshLab and Blender to make it a solid geometry and remove potential complications. Once the vessel segment was isolated and processed, it was exported as an STL file into a commercial solver from ANSYS, Inc., Canonsburg, PA, USA. Using a coupling system of the Ansys Fluent and Mechanical models, a transient Fluid-Solid Interaction (FSI) simulation was performed by coupling ANSYS' Fluent and Mechanical models. In the simulation, blood flowed steadily through the vessel, and the data for FSI was recorded. The software was used to simulate the deformation and stress of the blood vessels caused by the blood flow for elevated intracranial pressure events for five different durations and magnitudes. Following the FSI simulations, the total deformation, equivalent stress, dynamic pressure, static pressure, and fluid velocity were plotted. The results show that altering the pressure duration can increase average total vessel wall deformation by up to 356.35%, average equivalent stress by 331.11%, dynamic pressure by 19.28%, and decrease static pressure by 30.94%. Likewise, increasing the magnitude of pressure can also increase the dynamic pressure by 17.17 %, the maximum velocity by 16.77%, and can decrease the static pressure by 27.31%. The statistical behavior of each type of modification was unique, as altering the duration created a logarithmic plot while changing the magnitude of pressure created a second power plot. With the provided data, researchers will better understand the effects of NFS-like elevated intracranial pressure on cerebral vasculature. / Master of Science / Nonfatal strangulation (NFS) has been identified as a leading indicator of escalating partner violence. The first occurrence of NFS in an intimate partnership correlated with an 8-fold increase in the risk of future attacks that are fatal by that partner. While NFS does not result in the immediate death of the victim, it can still cause severe physical and psychological harm. This includes traumatic brain injury from lack of proper blood flow, increased intracranial pressure (ICP), and hypoxia. Quantitative research on strangulation injury has mainly been carried out by forensics researchers, resulting in a lack of understanding of the biomechanics of nonfatal strangulation. This lack of knowledge, coupled with the frequent absence of visible injuries in victims of NFS, makes diagnosing NFS events particularly difficult. This study aims to begin to fill this gap by developing a computational biomechanics model of a phenomenon that occurs during NFS. The model examines how altering the duration and magnitude of a pressure wave that mimics the increased intracranial pressure during NFS can impact the blood flow and vessel motions in an intracranial blood vessel. The blood vessel model was extracted from a computed tomography (CT) scan of a patient's skull, preprocessed, and transferred into ANSYS finite element modeling software. Fluid-solid interaction (FSI) simulations were performed in ANSYS, which allowed the study of blood pressure, blood velocity, vessel deformation, and vessel stress. The results showed that increasing either the magnitude or duration of the pressure wave caused an increase in vessel stress and deformation. The results also showed that doing either increased the maximum blood velocity and dynamic pressure while decreasing the static pressure of the blood. These results contribute toward the understanding of the biomechanics of nonfatal strangulation. The model developed in this project may serve as the foundation for more complex models in future studies.

The brain, like many parts of the human body, can experience swelling, also known as cerebral edema. Cerebral edema may occur because of an injury, health related issues, tumors, or even high altitudes[1]. When cerebral edema occurs, a rise in intracranial pressure (ICP) becomes prevalent and may cause a serious threat. Without immediate treatment, increased intracranial pressure can prevent blood from flowing to the brain and depriving it of necessary oxygen it needs to function. A normal ICP is usually between 5-15 mmHg (666 Pa - 1333Pa). Any ICP observed to be above 20 mmHg (2666Pa) can be associated with brain ischemia and is usually treated[2, 3]. If prolonged, high intracranial pressures can be fatal. Current methods of measuring increased ICP are invasive and may involve drilling into the skull. Extreme invasive measures are not always suitable for certain situations. This thesis presents a study of a non-invasive sensor using piezoelectric PVDF wire to measure the ICP. The PVDF wire sensor is wrapped around the outer portion of the human head to measure the integrated hoop strain. Using this hoop strain, the pressure is then calculated from a known coupling factor of strain to pressure outputted from finite element modeling simulations. The coupling factor is then incorporated into a final calibration factor to calibrate the piezoelectric PVDF wire sensor from charge (Picocoulomb) to pressure (Pascal). These calibration factors are proven to be primarily dependent on the circumference of the human skull. Furthermore, part of this study analyzed the effectiveness and validity of the sensor due to asymmetries in the human skull. A comparison of analytical analysis results versus computational results using finite element modeling simulations show that the PVDF wire sensor neglects any asymmetries presented within the test subject. The results of this study show that this sensor will output correct ICP measurements of different subjects using appropriate calibration factors and is a viable option for measuring ICP non-invasively. / Master of Science

A major goal in the care of patients with neurological problems is to prevent or minimize episodes of increased intracranial pressure (ICP). Elevations in ICP in response to nursing interventions have been acknowledged since the 1960’s when ICP monitoring was first introduced in the clinical setting. Until recently few studies have specifically examined the effect of oral care on ICP and oral care and other hygiene measures were combined or not specified, prohibiting a direct interpretation of the influence of oral care alone on ICP. The purpose of this study was to describe the relationship between routine oral care interventions and the changes in ICP specifically focusing on the effect of intensity and duration of this intervention. Twenty-three patients with a clinical condition requiring ICP monitoring were enrolled over a 12 month period. Oral care provided by neuroscience intensive care nurses was observed and videotaped. Characteristics of the intervention were documented including products used, patient positioning, and duration of the intervention. A 1-5 subjective scale was used to score intensity of oral care. Wrist actigraphy data were collected from the nurses to provide an objective measure of intensity. Patient physiologic data were collected at 12 second epochs 5 minutes before, during and 5 minutes after oral care. The mixed effect repeated measures ANOVA model indicated that there was a statistically significant increase in ICP in response to oral care (p=0.0031). There was, however, no clinically significant effect on ICP. This study provides evidence that oral care is safe to perform in patients in the absence of pre-existing elevated ICP.