Primary and Secondary Brain Stem Lesions

ISBN-13: 9783709189436 / Angielski / Miękka / 2012 / 130 str.

Gyorgy Csecsei; Oskar Hoffmann; Norfrid Klug

Opis

Lesions of the brain stem and related disorders of autonomous regulation systems have been the "Leitmotiv" of the scientific work in the Neurosurgical Department of the Giessen University under the leadership of the late Professor Hans Werner Pia. Some of the results have already been published in supplement volumes of Acta Neurochirurgica. The first one of these was Vol. 4 with the monograph written by H. W. Pia on "Die Schadigungen des Hirnstammes bei den raumfordernden Prozessen des Gehirns". Vol. 19 deals with central disorders of temperature regulation, written by G. Lausberg, followed by Vol. 20 with R. Lorenz's monograph on the effects of intracranial space-occupying lesions on blood pressure and heart rate. Shortly before his death Hans Werner Pia had asked me to combine and publish in this series of supplement volumes of Acta Neurochirurgica another five papers by his co-workers, also related to brain stem lesions and also to cerebral blood flow and CSF dynamics. The result is this volume which contains work dealing with the CT -findings of cerebral mass displacements and their clinical correlations (Sch6nmayr), with other lesions of the brain stem (Laun), with the blink reflex and acoustic evoked potentials in brain stem lesions (Klug and Csecsei), with blood flow in brain structures during increased ICP (Zierski) and with the description of a mathematical model for analysis and simulation of the haemodynamics of intracranial CSF (Hoffmann).

Spis treści

Cerebral Mass Displacements. Part I: Cisternal Hernia in Intracranial Tumours in the Computer Tomogram.- Materials and Methods.- Results.- Influence of Tumour Location on Alterations of the Cisterns.- 1. Tumours of the Frontal Lobe.- 1.1. Frontal Tumours.- 1.2. Frontobasal Tumours.- 1.3. Frontolateral Tumours.- 1.4. Summary.- 2. Tumours of the Temporal Lobe.- 2.1. Temporal Tumours.- 2.2. Temporobasal Tumours.- 3. Tumours of the Parietal Lobe.- 4. Tumours of the Occipital Lobe.- 5. Tumours of the Basal Ganglia.- 6. Tumours of the Posterior Cranial Fossa.- 6.1. Midline Tumours.- 6.2. Tumours of the Cerebellar Hemispheres.- 6.3. Extracerebral Tumours of the Posterior Cranial Fossa.- 7. Occlusive Hydrocephalus.- Discussion.- References.- Cerebral Mass Displacements. Part II: Clinical Findings in Primary and Secondary Brain Stem Lesions.- Patients and Methods.- Results.- 1. Individual Parameters and Their Combinations.- 2. Progress Investigations.- 3. Summary.- Discussion.- References.- Acute Direct and Indirect Lesions of the Brain Stem — CT Findings and Their Clinical Evaluation.- Summary.- Material and Methods.- Results.- 1. Supratentorial Lesions.- 1.1. Acute Supratentorial Lesions.- 1.2. Decerebration Without Herniation.- 1.3. Discussion of Supratentorial Lesions.- 2. Infratentorial Lesions.- 2.1. Acute Infratentorial Lesions.- 2.2. Subacute Infratentorial Lesions.- 2.3. Discussion of Infratentorial Lesions.- 3. Direct Changes in the Brain Stem.- 3.1. Hyperdense Lesion.- 3.1.1. Traumatic Direct and Indirect Brain Stem Haemorrhage.- Discussion of Traumatic Brain Stem Haemorrhages.- 3.1.2. Spontaneous Brain Stem Haemorrhage.- Discussion of Spontaneous Brain Stem Haemorrhages.- 3.2. Hypodense Brain Stem Lesions.- 3.2.1. Brain Stem Infarcts.- Discussion of Brain Stem Infarcts.- 3.2.2. Basilar Artery Occlusion.- Discussion of Basilar Artery Occlusions.- 4. Indirect Secondary Infarcts of the Brain Stem and Other Regions.- Discussion of the Indirect Secondary Infarcts.- References.- Electrically Elicited Blink Reflex and Early Acoustic Evoked Potentials in Circumscribed and Diffuse Brain Stem Lesions.- 1. Introduction and Objectives.- 2. Historical Review.- 2.1. Blink Reflex.- 2.2. Early Acoustic Evoked Potentials (BAEP).- 3. Materials and Methods.- 3.1. Clinical Investigations.- 3.1.1. Blink Reflex.- 3.1.2. Brain Stem Acoustic Evoked Potentials.- 3.2. Experimental Investigations.- 3.2.1. Blink Reflex.- 3.2.2. Acoustic Evoked Potentials.- 3.2.3. Investigation of the Blood-Brain Barrier.- 4. Results.- 4.1. Normal Findings.- 4.1.1. BR.- 4.1.2. BAEP.- 4.2. Circumscribed Processes with Involvement of the Brain Stem.- 4.2.1. Cerebellar Space Occupations.- 4.2.1.1. BR.- 4.2.1.2. BAEP.- 4.2.2. Cerebellopontine Angle Tumours.- 4.2.2.1. BR.- 4.2.2.2. BAEP.- 4.2.3. Space-Occupying Processes of the Brain Stem.- 4.2.3.1. Blink Reflex.- 4.2.3.1.1. M Response.- 4.2.3.1.2. R1 Response.- 4.2.3.1.3. R2 Response.- 4.2.3.2. BAEP.- 4.2.4. Discussion.- 4.2.5. The Significance of Pontomesencephalic Structures in the Development of the Late Component of BR (R2).- 4.2.5.1. Discussion.- 4.3. Diffuse Acute Processes with Involvement of the Brain Stem.- 4.3.1. Blink Reflex.- 4.3.1.1. BR Findings in Acute Midbrain Syndrome.- 4.3.1.2. BR Findings in Apallics, in Bulbar Syndrome and Brain Death.- 4.3.1.3. The Blink Reflex as Prognostic Criterion.- 4.3.1.4. Discussion.- 4.3.2. BAEP.- 4.3.2.1. BAEP in Acute Midbrain Syndrome.- 4.3.2.1.1. Interpeak Latencies.- 4.3.2.1.2. Amplitude Ratios.- 4.3.2.1.3. “Morphological” Structure of Individual Potential Components and Latency Instability.- 4.3.2.1.4. BAEP, Lesion Level and Neurological Brain Stem Symptoms.- 4.3.2.1.5. BAEP Findings Differing on the Right and Left Side.- 4.3.2.1.6. BAEP Findings in Bulbar Syndrome and Brain Death.- 4.3.2.1.7. The Prognostic Significance of BAEP.- 4.3.2.1.8. Discussion.- 4.4. Experimental Findings.- 4.4.1. Normal Findings.- 4.4.1.1. Blink Reflex.- 4.4.1.2. Acoustic Evoked Potentials.- 4.4.2. Results During the Elevation of Intracranial Pressure.- 4.4.2.1. Pathophysiological Findings.- 4.4.2.2. Blink Reflex.- 4.4.2.3. Acoustic Evoked Potentials.- 4.4.2.4. Pathomorphological and Histopathological Findings.- 4.4.2.4.1. Macroscopic Findings.- 4.4.2.4.2. Fluorescence Microscopy Findings.- 4.4.2.4.3. Light Microscopic Investigations.- 4.4.2.4.4. Electron Microscopic Investigations.- 4.4.3. Discussion.- 5. Summary.- References.- Blood Flow in Brain Structures During Increased ICP.- Summary.- Material and Methods.- 1. Blood Flow Measurement.- 2. Experimental Protocol.- Results.- 1. Control Values.- 2. Effect of ICP upon Systemic Measurements.- 3. Macroscopic Changes.- 4. rCBF in the Initial Phase of ICP Increase.- 5. Effect of ICP upon Regional CBF.- 5.1. Comparison of Regional Flows with Total Brain Flow.- 5.2. Comparison of Left and Right Side Flows.- 5.3. Brain Stem Flow.- 5.4. Comparison of Control Flow with Final Flow.- 6. Influence of ABP.- 6.1. Effect of ICP Increase upon Flow in the Spine, Heart and Kidneys.- 6.2. CBF After Cerebral Ischaemia.- Discussion.- Acknowledgements.- References.- Biomathematics of Intracranial CSF and Haemodynamics. Simulation and Analysis with the Aid of a Mathematical Model.- Summary.- Model Equations.- 1. Intracranial System.- 2. Cardiovascular Components.- 3. Baroreceptor Feedback Control.- 4. Disturbance of Central Regulation.- 5. Space Occupying Lesions.- Stability, Model Validation and Simulation Technique.- Model Applications.- 1. Intracranial Pulse Pressure Relationship and Haemodynamics.- 2. Volume Pressure Test and Haemodynamics.- 3. Parameter Estimation.- 4. Rhythmic Phenomena.- Discussion.- References.