지원사업
학술연구/단체지원/교육 등 연구자 활동을 지속하도록 DBpia가 지원하고 있어요.
커뮤니티
연구자들이 자신의 연구와 전문성을 널리 알리고, 새로운 협력의 기회를 만들 수 있는 네트워킹 공간이에요.
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초록· 키워드
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Malignant cerebral edema following ischemic stroke is life threatening, as it can cause inadequate blood flow and perfusion leading to irreversible tissue hypoxia and metabolic crisis. Increased intracranial pressure and brain shift can cause herniation syndrome and finally brain death. Multiple randomized clinical trials have shown that preemptive decompressive hemicraniectomy effectively reduces mortality and morbidity in patients with malignant middle cerebral artery infarction. Another life-saving decompressive surgery is suboccipital craniectomy for patients with brainstem compression by edematous cerebellar infarction. In addition to decompressive surgery, cerebrospinal fluid drainage by ventriculostomy should be considered for patients with acute hydrocephalus following stroke. Medical treatment begins with sedation, analgesia, and general measures including ventilatory support, head elevation, maintaining a neutral neck position, and avoiding conditions associated with intracranial hypertension. Optimization of cerebral perfusion pressure and reduction of intracranial pressure should always be pursued simultaneously. Osmotherapy with mannitol is the standard treatment for intracranial hypertension, but hypertonic saline is also an effective alternative. Therapeutic hypothermia may also be considered for treatment of brain edema and intracranial hypertension, but its neuroprotective effects have not been demonstrated in stroke. Barbiturate coma therapy has been used to reduce metabolic demand, but has become less popular because of its systemic adverse effects. Furthermore, general medical care is critical because of the complex interactions between the brain and other organ systems. Some challenging aspects of critical care, including ventilator support, sedation and analgesia, and performing neurological examinations in the setting of a minimal stimulation protocol, are addressed in this review.
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참고문헌 (25)
참고문헌 신청
Adler DE. / 2002 / The tentorial notch : anatomical variation, morphometric analysis, and classification in 100 human autopsy cases / J Neurosurg 96 : 1103 ~ 1112
Brazis PW / 2007 / Localization in Clinical Neurology. 5th ed / Lippincott Williams & Wilkins : 557 ~ 582
Chesnut RM. / 2012 / A trial of intracranial-pressure monitoring in traumatic brain injury / N Engl J Med 367 : 2471 ~ 2481
Czosnyka M. / 2013 / Increased intracranial pressure : what to do about it and when? / Crit Care Med 41 : 688 ~
Garcia-Morales EJ. / 2004 / Osmole gap in neurologic-neurosurgical intensive care unit : Its normal value, calculation, and relationship with mannitol serum concentrations /
Brazis PW / 2007 / Localization in Clinical Neurology. 5th ed / Lippincott Williams & Wilkins : 557 ~ 582
Chesnut RM. / 2012 / A trial of intracranial-pressure monitoring in traumatic brain injury / N Engl J Med 367 : 2471 ~ 2481
Czosnyka M. / 2013 / Increased intracranial pressure : what to do about it and when? / Crit Care Med 41 : 688 ~
Garcia-Morales EJ. / 2004 / Osmole gap in neurologic-neurosurgical intensive care unit : Its normal value, calculation, and relationship with mannitol serum concentrations /
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