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Background: The disruption of intracranial fluid dynamics due to large unruptured cerebral arteriovenous malformation (AVM) commonly triggers a domino effect within the central nervous system. This phenomenon is frequently overlooked in prior clinic and may lead to catastrophic misdiagnoses. Our team has documented the world's first case of so-called AVM Pentalogy (AVMP) induced by a AVM. Clinical presentation and result: A 30-year-old female was first seen 9years ago with an occasional fainting, at which time a huge unruptured AVM was discovered. Subsequently, due to progressive symptoms, she sought consultations from several prestigious neurosurgical departments in China, where all consulting neurosurgeons opted for conservation treatment due to perceived surgical risks. During the follow-up period, the patient gradually presented with hydrocephalus, empty sella, secondary Chiari malformation, syringomyelia, and scoliosis (we called as AVMP). When treated in our department, she already displayed numerous symptoms, including severe intracranial hypertension. Our team deduced that the hydrocephalus was the primary driver of her AVMP symptoms, representing the most favorable risk profile for intervention. As expected, a ventriculoperitoneal shunt successfully mitigated all symptoms of AVMP at 21-months post-surgical review. Conclusion: During the monitoring of unruptured AVM, it is crucial to remain vigilant for the development or progression of AVMP. When any component of AVMP is identified, thorough etiological studies and analysis of cascade reactions are imperative to avert misdiagnosis. When direct AVM intervention is not viable, strategically addressing hydrocephalus as part of the AVMP may serve as the critical therapeutic focus. [ABSTRACT FROM AUTHOR]

Patients with cerebral venous sinus thrombosis (CVST) may die during the acute phase due to increased intracranial pressure and cerebral herniation. The purpose of this study was to assess the role of decompressive craniectomy in the treatment of patients with malignant CVST. Patients who underwent decompressive craniectomy and were consequently admitted to the Critical Care Unit, Department of Neurosurgery, at Capital Medical University Xuanwu Hospital from March 2010 to January 2021 were retrospectively examined with follow-up data at 12 months. In total, 14 cases were reviewed, including 9 female and 5 male patients, aged 23–63 years (42.7 ± 12.3 years). Prior to surgery, all patients had a GCS score <9. 6 patients had a unilateral dilated pupil, while 4 patients had bilateral dilated pupils. According to the head computed tomography (CT), all patients had hemorrhagic infarction, and the median midline shift was 9.5 mm before surgery. Thirteen patients underwent unilateral decompressive craniectomy, and 1 patient underwent bilateral decompressive craniectomy, among whom, 9 patients underwent hematoma evacuation. Within 3 weeks of surgery, 3 cases (21.43%) resulted in death, with 2 patients dying from progressive intracranial hypertension and 1 from acute respiratory distress syndrome (ARDS). Eleven patients (78.57%) survived after surgery, of whom 4 (28.57%) patients recovered without disability at 12-month follow-up (mRS 0–1), 2 (14.29%) patients had moderate disability (mRS 2–3), and 5 (35.71%) patients had severe disability (mRS 4–5). Emergent decompressive craniectomy may provide a chance for survival and enable patients with malignant CVST to achieve an acceptable quality of life (QOL). [ABSTRACT FROM AUTHOR]

Introduction: Cerebral venous thrombosis (CVT) is a rare subtype of stroke. However, existing scales were insufficient to evaluate the overall severity of CVT. The aim of this study is to develop and validate a CVT severity scale.Methods: Items 1– 11 were directly derived from NIHSS. New items were generated from a literature review and focus group discussion. A total of 170 CVT patients were prospectively recruited from 26 top tertiary hospitals in China Mainland from January 2021 to May 2022 to validate the CVT severity scale. The CVT severity scale, NIHSS, mRS and GCS were rated at admission. The lumbar puncture opening pressure was also recorded. Twenty randomly selected CVT patients were rated with the CVT severity scale again 24 hours later. The clinical outcome of CVT was evaluated by mRS at 6 months after baseline.Results: We successfully established a CVT severity scale with 18 items. Exploratory factor analysis showed that 18 items were attributed to factor 1 (focal neurological deficits), factor 2 (diffuse encephalopathy), factor 3 (intracranial hypertension) and factor 4 (cavernous sinus syndrome). CVT severity scale was positively correlated with ICP, NIHSS and mRS, and negatively correlated with GCS at baseline. CVT severity scale > 3 or factor 3 > 2 indicated intracranial hypertension. CVT severity scale > 10 indicated poor clinical outcome at 6 months of follow-up. Meanwhile, CVT severity scale showed high internal consistency and test–retest reliability.Conclusion: The CVT severity scale included 18 items encompassing 4 domains of focal neurological deficits, diffuse encephalopathy, IH and cavernous sinus syndrome. CVT severity scale correlated well with ICP, NIHSS, mRS and GCS. Patients with CVT severity scale > 10 can be defined as severe CVT. The CVT severity scale may serve as a valid and reliable tool for measuring the overall severity of CVT. [ABSTRACT FROM AUTHOR]

Background: Neuro-Behçet's disease (NBD), characterized by isolated intracranial hypertension, is a rarely encountered condition, especially in children. In this study, we describe the treatment of a pediatric patient with NBD, who exhibited isolated intracranial pressure elevation as indicated by the initial manifestation of diplopia and physical examination finding of papilledema. Case presentation: An 8-year-old boy was admitted to the hospital with a confirmed diagnosis of Behçet's disease (BD) over eight months. The patient also presented with the symptom of diplopia for three days. The evaluation of the patient's nervous system did not reveal any apparent abnormalities. The measurement of cerebrospinal fluid pressure yielded a reading of 470 mm H2O. The examination of the fundus indicated papilledema, and imaging scans revealed evidence of focal demyelination. The symptoms of the child showed alleviation after the administration of mannitol, methylprednisolone, and azathioprine. Furthermore, this study involved a comprehensive analysis of 18 cases of NBD with isolated intracranial hypertension, comprising one case reported herein and 17 cases from the literature review. Three cases were children, and an equal distribution of males and females 9:9 was noted. The average age at the onset of symptoms was 24.7 years (8-38 years). Headache (90%) was the most commonly reported clinical manifestation, followed by blurred vision or diplopia (80%). The ocular manifestations included papilledema (100%), abducent nerve paralysis (20%) and local eye hemorrhages in the retina (30%). Notably, 88.9% of these ocular manifestations were relieved or cured after treatment. Conclusion: This study presents the first reported case of NBD with isolated intracranial hypertension in the pediatric population of China. In a child with Bechet's disease presenting with features of raised intracranial pressure, it is important to be aware of neuro Bechet's presenting with intracranial hypertension without other neurological abnormalities. This will help make early diagnosis, institute treatment and prevent sequelae resulting from untreated raised intracranial pressure. [ABSTRACT FROM AUTHOR]

• The sequence type 5 (ST5) lineage caused a significant burden on HIV-negative hosts in East Asia. • The high ST5 lineage infection rate was not due to environmental abundance. • Seven factors predicted acute death in patients without HIV who were infected with ST5 lineage. • We provided an understanding of the ST5 lineage associated with cryptococcosis. Cryptococcus neoformans sequence type 5 (ST5) lineage could infect immunocompetent hosts and cause a significant medical burden. We sought to identify characteristics and prognostic risk factors of ST5 lineage-associated cryptococcosis. Multilocus sequence typing and antifungal susceptibility testing were conducted for Cryptococcus isolates. The clinical and laboratory characteristics of cryptococcosis patients were investigated. The multivariable logistic regression identified variables independently associated with 30-day mortality in patients with ST5 lineage-associated cryptococcosis without HIV. The infection rate of the ST5 isolates was 89.4% (370/414) in China. The proportion of ST5 isolates with nonwild-type minimum inhibitory concentrations to amphotericin B, 5-flucytosine, voriconazole, posaconazole, itraconazole, and fluconazole were 0%, 5.4%, 0.3%, 1.4%, 0.3%, and 8.1%, respectively. The ST5 lineage-infected group exhibited significantly higher blood platelet count, lower blood cryptococcal antigen (CrAg) titer, lower cerebrospinal fluid (CSF) CrAg titer than the non-ST5 lineage-infected group, and lower hemoglobin and lower CSF CrAg titer than the Cryptococcus gattii isolates-infected group. Seven baseline parameters, including underlying disease, dyskinesia, anemia, high peripheral blood neutrophils, low platelet count, high CSF fungal burden, and high CSF opening pressure, were associated independently with the 30-day mortality of patients with ST5 lineage-associated cryptococcosis without HIV. Our study has provided an understanding of the ST5 lineage associated with cryptococcosis. [ABSTRACT FROM AUTHOR]

Objective This paper reports a case of malignant intracranial hypertension, reviews his diagnosis and treatment, and analyzes his etiology, in order to improve the clinicians' cognition of this disease. Methods and Results The patient was a 19-year-old male with subacute onset and chronic course of disease, presenting with amaurosis, headache, neck and shoulder pain, blurred vision and tinnitus disease. Imaging findings showed cerebral venous sinus stenosis (VSS) with obvious pressure difference at both ends of stenosis. However, venous sinus stenting was ineffective. After optic nerve sheath decompression, the symptoms of headache and blurred vision were not significantly improved. Finally, the patient was diagnosed as glioblastoma (WHO IV), and died 8 months after removal of the tumor foci. Conclusions Patients with the pressure difference at both ends of malignant intracranial hypertension with VSS should not take stenting. Clarifying the cause and type of stenosis is very important for correct diagnosis and guide treatment. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical significance of "Olive - Tipped" technique during cerebral venous sinus stenosis stenting. Methods A total of 79 patients (including 57 patients with intracranial hypertension and 22 patients with pulsatile tinnitus) who were diagnosed with cerebral venous sinus stenosis (VSS) and underwent stenting in Department of the First Medical Center of Chinese PLA General Hospital from January 2017 to May 2021 were retrospectively collected. The characteristics of Labbe vein in patients with "Olive-Tipped" technique, the changes of pressure difference at both ends of stenosis before and after surgery in patients with intracranial hypertension were analyzed. The improvement of postoperative stenosis and venous reflux, the improvement of postoperative intracranial hypertension and pulsatile tinnitus, the success rate of stenting and the utilization rate of "Olive - Tipped" technique were observed. Results All the stents were successfully placed (79/79). Immediate DSA after procedure showed no venous stasis in all patients, and residual stenosis was < 30%. "Olive-Tipped" technique was used in 23 patients (29.11%) to assist the stent in place due to the guiding catheter and stent could not reach the predetermined position smoothly. The diameter of the confluence of Labbe vein and venous sinus in the "Olive-Tipped" technique group was significantly larger than that in the conventional technique group t = 7.041, P = 0.000). The pressure difference between the two ends of venous sinus stenosis in patients with intracranial hypertension was 15.00 (11.00, 21.50) mm Hg before surgery and 1 (0, 2) mm Hg immediately after surgery, the difference was statistically significant (Z = - 6.573, P = 0.000). The tinnitus sympoms of 22 patients with pulsatile tinnitus caused by cerebral venous sinus stenosis disappeared immediately or visibly lightened. Conclusions The diameter of the confluence of Labbe vein and venous sinus can be used as an index to evaluate whether the stent is easy to implant before the surgery. The dilated Labbe vein confluence is easy to cause the guiding catheter and stent to get stuck, and the stent is difficult to be in place. The use of "Olive-Tipped" technique can significantly improve the success rate of the surgery. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effectiveness of therapeutic lumbar drainage (LD) compared to therapeutic lumbar puncture (LP) for the management of intracranial hypertension (ICH) among HIV-positive patients with cryptococcal meningitis (CM). The study was a multicenter prospective non-randomized interventional clinical trial. One hundred and sixteen HIV-associated CM patients were identified who presented with ICH (≥250 mmH2O). The LP group comprised 76 cases, while the LD group consisted of 40 cases. We compared mortality, intracranial pressure (ICP) normalization rate, and clinical symptom remission at 10 weeks, between the two groups. The cumulative mortality at week 10 was 22.4% in the LP group and 20% in the LD group (p =.927), without any significant difference in mortality between the two groups. Improvement after treatment at 2-weeks, ICP normalization, and headache reversal event occurrence in the two groups showed no significant difference (p >.05). The incidence of CSF Cryptococcus clearance at two weeks in the LD group was significantly higher than in the LP group (p <.05). The frequency of invasive lumbar therapeutic procedures in the LP group during the first week was higher than that of the LD group (p <.05). Localized infection at the puncture site occurred more frequently in the LD group than in the LP group (p <.05). For HIV-positive CM patients with an elevated ICP, LD and LP are comparably effective and safe options to normalize ICP. LP increases the frequency of invasive lumbar therapeutic procedures but does not incur more risk of infection events at the puncture site, while LD may accelerate CSF Cryptococcus clearance but may induce more frequent localized infection. This study was registered as one of 12 trials under a general project at the Chinese Clinical Trial Registry (ChiCTR1900021195). [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to explore the precipitating factors and evaluate the impact of different stenosis types on treatment outcomes in patients with idiopathic intracranial hypertension (IIH) and venous sinus stenosis (VSS). Methods: We recruited patients with IIH who presented with VSS, either intrinsic or extrinsic. We observed the clinical and laboratory findings, and we then compared the outcomes of stenting and medical treatment in different stenosis types. Results: Among 145 patients with IIH and VSS, 59 were of the intrinsic type and 86 were of the extrinsic type. Patients in the intrinsic group were older (42 vs. 34 years old, P < 0.001) and presented with higher pre-op gradient pressure (15 mmHg vs. 12 mmHg, P < 0.001). There was no significant difference between groups regarding other precipitating factors (P > 0.05). Stenting was significantly associated with complete resolution of the headache and impaired vision both in intrinsic (adjusted OR 0.017, 95% CI 0.001–0.35, P = 0.011; adjusted OR 0.056, 95% CI 0.004–0.697, P = 0.025, respectively) and extrinsic types of stenosis (adjusted OR 0.072, 95% CI 0.015–0.343, P = 0.001; adjusted OR 0.241, 95% CI 0.062–0.931, P = 0.039, respectively). Meanwhile, stenting was significantly associated with improvement of the papilledema in extrinsic-type stenosis compared with medical treatment (adjusted OR 0.017, 95% CI 0.002–0.135, P < 0.001). Conclusion: Stenting may provide substantial clinical improvement in patients with IIH regardless of intrinsic or extrinsic stenosis type in our patient population, as noted in other series. Trial Registration: Clinical trial registration number ChiCTR-ONN-17010421. [ABSTRACT FROM AUTHOR]

Introduction: Idiopathic normal pressure hydrocephalus (iNPH) is one of the potentially reversible dementias. Early and accurate diagnosis is important for patients' prognosis. Emerging evidence shows fluid biomarkers are useful in diagnosis and pathophysiological research of iNPH. Methods: Probable iNPH and Alzheimer's disease (AD) patients were recruited. Clinical diagnosis was performed according to international guidelines. CSF collection complied with a standard protocol. Commercial accessible ELISA kits were introduced for measurement of CSF t-tau, p-tau181, Aβ42, and NfL. Results: Twenty-seven iNPH, 27 AD, and 18 controls were included. The profiles of CSF t-tau, p-tau181, and t-tau/Aβ42 in the iNPH and AD were significantly different (p < 0.0001). The profiles of CSF t-tau, p-tau181, and t-tau/Aβ42 in the iNPH and control were not different (p > 0.05). Level of CSF Aβ42 in iNPH was significantly lower than control (p < 0.0001) and also significantly higher than AD (p < 0.05). NfL level in iNPH and AD was increased, but its level in iNPH was significantly lower than that in AD (p = 0.005). NfL and t-tau level in the iNPH group was significantly correlated (coefficient = 0.649, p = 0.005), but not in AD (coefficient = 0.298, p = 0.157). Conclusion: Alzheimer's CSF biomarker profile of iNPH subjects showed moderately decreased Aβ42 and normal t-tau, p-tau181, and t-tau/Aβ42, which was distinguishable from AD. The different profiles and correlation of t-tau and NfL suggested different pathophysiology of AD and iNPH. t-tau was relatively an AD-specific neurodegenerative biomarker compared to NfL. [ABSTRACT FROM AUTHOR]

Objective: Decompressive craniectomy (DC) plays an important role in the treatment of patients with severe traumatic brain injury (sTBI) with mass lesions and intractably elevated intracranial hypertension (ICP). However, whether DC should be performed in patients with bilateral dilated pupils and a low Glasgow Coma Scale (GCS) score is still controversial. This retrospective study explored the clinical outcomes and risk factors for an unfavorable prognosis in sTBI patients undergoing emergency DC with bilateral dilated pupils and a GCS score <5. Methods: The authors reviewed the data from patients who underwent emergency DC from January 2012 to March 2019 in a medical center in China. All data, such as patient demographics, radiological findings, clinical parameters, and preoperative laboratory variables, were extracted. Multivariate logistic regression analysis was performed to determine the factors associated with 30-day mortality and 6-month negative neurological outcome {defined as death or vegetative state [Glasgow Outcome Scale (GOS) score 1–2]}. Results: A total of 94 sTBI patients with bilateral dilated pupils and a GCS score lower than five who underwent emergency DC were enrolled. In total, 74 patients (78.7%) died within 30 days, and 84 (89.4%) had a poor 6-month outcome (GOS 1–2). In multivariate analysis, advanced age (OR: 7.741, CI: 2.288–26.189), prolonged preoperative activated partial thromboplastin time (aPTT) (OR: 7.263, CI: 1.323–39.890), and low GCS (OR: 6.162, CI: 1.478–25.684) were associated with a higher risk of 30-day mortality, while advanced age (OR: 8.812, CI: 1.817–42.729) was the only independent predictor of a poor 6-month prognosis in patients undergoing DC with preoperative bilateral dilated pupils and a GCS score <5. Conclusions: The mortality and disability rates are extremely high in severe TBI patients undergoing emergency DC with bilateral fixed pupils and a GCS score <5. DC is more valuable for younger patients. [ABSTRACT FROM AUTHOR]

Viral encephalitis in children caused by multiple viral infections, as a common central nervous system disease in pediatrics, has a high incidence in China. Its clinical symptoms usually include infection, poisoning, intracranial hypertension, and disturbance of consciousness. In severe cases, it can even endanger the lives of patient children. At present, the clinical treatment of the viral encephalitis mainly uses traditional Chinese medicine preparations such as Reduning Injection. The efficacy is significant. It can not only relieve the uncomfortable symptoms in a short time, but also has low incidence of adverse reactions. In this study, the factors that cause viral encephalitis in children were analyzed, and the efficacy, pharmacological action and clinical application of Reduning Injection were comprehensively elaborated, to provide a reference for clinical doctors to rationally treat viral encephalitis in children. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) poses a huge public health and societal problem worldwide. Uncertainty exists on how care system and treatment approaches for TBI worked in China may differ from those in Europe. Better knowledge on this is important to facilitate interpretation of findings reported by Chinese researchers and to inform opportunities for collaborative studies. We aimed to investigate concordance and variations in TBI care between Chinese and European neurotrauma centers. Investigators from 52 centers in China and 68 in Europe involved in the Collaborative European Neuro Trauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study were invited to complete provider profiling (PP) questionnaires, which covered the main aspects of care system and treatment approaches of TBI care. Participating Chinese and European centers were mainly publicly funded and academic. More centers in China indicated available dedicated neuro-intensive care than those in Europe (98% vs. 60%), and treatment decisions in the ICU were mainly determined by neurosurgeons (58%) in China while in Europe, (neuro)intensivists often took the lead (61%). The ambulance dispatching system was automatic in half of Chinese centers (49%), whereas selective dispatching was more common in European centers (74%). For treatment of refractory intracranial hypertension, a decompressive craniectomy was more frequently regarded as general policy in China compared with in Europe (89% vs. 45%). We observed both concordance and substantial variations with regard to the various aspects of TBI care between Chinese and European centers. These findings are fundamental to guide future research and offer opportunities for collaborative comparative effectiveness research to identify best practices. [ABSTRACT FROM AUTHOR]

Objective To analyze the clinical characteristics of idiopathic intracranial hypertension (IIH) to improve the diagnosis rate. Methods Epidemiological characteristics, clinical manifestations, imaging examination results and treatment outcomes of 153 patients with IIH hospitalized in Beijing Tongren Hospital from January 2014 to May 2018 were analyzed retrospectively. The clinical differences between subacute group (14 d to 3 months) and chronic group (> 3 months) were compared. Results One hundred and fifty-three cases (subacute group 94 cases and chronic group 59 cases) were observed. There were 37 males and 116 females (1 :3.14), 53 obses cases (34.64%), 67 overweight case (43.80%). The main clinical symptoms were visiual loss (77.78%, 119/153), transient visual obscuration (50.33%, 77/153), headache (45.10%, 69/153). Abnormal radiologic signs, including empty sella, distension of the perioptic subarachnoid space (DPSS) and transverse venous sinus stenosis (TVSS) were found in 98 cases (64.05%). Intracranial pressures (ICP) of 112 cases (73.20%) were above 30 cm H2O. After treatments (138 cases underwent routine treatments and 15 cases underwent surgery treatments), 86.93% (133/153) patients achieved clinical improvement. The improvement rate of subacute group was significantly higher than that of chronic group [91.49% (86/94) vs. 79.66% (47/59); χ² = 4.463, P = 0.035]. The incidence of transient visual obscuration in subactue group was significantly lower than that in chronic group [42.55% (40/94) vs. 62.71% (37/59); χ² = 5.892, P = 0.015]. No significant differtences of vision loss, headache, tinnitus, diplopia, abnormal image signs or ICP were deteced in patients between subacute group and chronic group. Conclusions IIH is one of the most important causes of vision loss and headache. Women in childbearing period and obese people are susceptible to IIH. Clinicians need to raise the awareness of IIH and give timely treatments. [ABSTRACT FROM AUTHOR]

Background: Cryptococcal meningitis (CM) is the most common fungal infection of the central nervous system and has high morbidity and mortality. Almost studies about prognostic factors have largely focused on the immunocompromised population rather than immunocompetent patients. So that we sought to conduct a retrospective study to determine prognostic factors which predict the outcomes in immunocompetent patients with CM.Methods: We retrospectively collected and analyzed the demographic and clinical data of 76 apparently immunocompetent patients with cryptococcal meningitis from January 2003 to June 2019 in China. The clinical outcome was graded by the Glasgow outcome scale (GOS) at discharge, and patients were divided into good (score of 5) and unfavorable (score of 1-4) outcome groups, potential prognostic factors were analyzed.Results: Non-parametric test confirmed that unfavorable outcome was associated with lower glucose level of CSF(P = 0.001), and Pearson's χ2 analysis confirmed that unfavorable outcome was associated with opening pressure of CSF(>300mmH20, P = 0.038), impaired consciousness (P = 0.001), hydrocephalus(P = 0.045), and Shunt surgery (P = 0.045), and then multiple logistic regression analysis confirmed that impaired consciousness(P = 0.015) and lower glucose concentration of CSF(P = 0.012) increased the likelihood of unfavorable outcome in CM patients.Conclusion: Impaired consciousness and decreased glucose concentration of CSF were independently prognostic factors which predict the unsatisfactory outcome in immunocompetent patients with CM. [ABSTRACT FROM AUTHOR]

Background: The risk factors of predicting the need for postoperative decompressive craniectomy due to intracranial hypertension after primary craniotomy remain unclear. This study aimed to investigate the value of intraoperative intracranial pressure (ICP) monitoring in predicting re-operation using salvage decompressive craniectomy (SDC).Methods: From January 2008 to October 2014, we retrospectively reviewed 284 patients with severe traumatic brain injury (STBI) who underwent craniotomy for mass lesion evacuation without intraoperative brain swelling. Intraoperative ICP was documented at the time of initial craniotomy and then again after the dura was sutured. SDC was used when postoperative ICP was continually higher than 25 mmHg for 1 h without a downward trend. Univariate and multivariate analyses were applied to both initial demographic and radiographic features to identify risk factors of SDC requirement.Results: Of 284, 41 (14.4%) patients who underwent SDC had a higher Initial ICP than those who didn't (38.1 ± 9.2 vs. 29.3 ± 8.1 mmHg, P < 0.001), but there was no difference in ICP after the dura was sutured. The factors which have significant effects on SDC are higher initial ICP [odds ratio (OR): 1.100, 95% confidence interval (CI): 1.052-1.151, P < 0.001], older age (OR: 1.039, 95% CI: 1.002-1.077, P = 0.039), combined lesions (OR: 3.329, 95% CI: 1.199-9.244, P = 0.021) and early hypotension (OR: 2.524, 95% CI: 1.107-5.756, P = 0.028). The area under the curve of multivariate regression model was 0.771.Conclusions: The incidence of re-operation using SDC after craniotomy was 14.4%. The independent risk factors of SDC requirement are initial ICP, age, early hypotension and combined lesions. [ABSTRACT FROM AUTHOR]

Objective: Resolution of a traumatic acute subdural haematoma (ASDH) requires weeks or months. However, cases of rapid spontaneous resolution of ASDH within 72 hours after trauma have been reported. The purpose of this study was to obtain a better understanding of the clinical and CT features of cases of rapid resolution following traumatic ASDH. Method: Between 2011–2014, the authors retrospectively collected data from 14 patients with rapid resolution of traumatic ASDH. The clinical data and CT findings of these cases were collected and analysed. Results: In 13 of the 14 patients, there was a rapid spontaneous resolution of the ASDH within 48 hours. The mean haematoma width of the second CT was significantly smaller than the width of the initial CT. A significantly marked resolution of the midline shift was observed in the second CT in all patients. The outcome was good in the majority of patients. Conclusions: The acute fluctuation of ICP may drive the spontaneous rapid resolution and redistribution of ASDH. Patients with abnormal coagulant function may be more likely to experience rapid resolution of ASDH. A band of low density in the initial CT image may be a useful sign for rapid resolution of ASDH. [ABSTRACT FROM PUBLISHER]

Background: Measurement of optic nerve sheath diameter (ONSD) is a fast and non-invasive method in detecting elevated intracranial pressure. However, the reported normal range of ONSD was inconsistent. The objective of the study was to determine the normal range of ONSD in healthy Chinese adults. Methods: Eyeball transverse diameter (ETD), optic nerve diameter (OND), and ONSD were measured by ultrasound examination in healthy adult volunteers. The OND and ONSD were assessed 3 mm behind the globe. The section showing maximal transverse diameter of the eyeball was frozen and the diameter was measured. Each ETD, OND and ONSD was examined twice and the mean value was calculated. Results: A total of 519 healthy volunteers were included in the study. The median (interquartile range) of ETD, OND and ONSD were 22.3 (21.6 to 23.1) mm, 3.2 (2.9 to 3.4) mm, and 5.1 (4.7 to 5.4) mm, respectively. The 95 % percentile of ONSD was 5.9 mm. There was no significant difference in ETD, OND or ONSD between male and female, or between left and right eye. ONSD was significantly correlated with OND (r = 0.62, P < 0.001), and the median OND/ONSD ratio (interquartile range) was 0.63 (0.59 to 0.67). Conclusions: The median and the 95 % percentile of sonographic measurement of ONSD are 5.1 mm and 5.9 mm in healthy Chinese adults. The ONSD is correlated with OND, while independent of gender, age, height, weight and ETD. The median OND/ONSD ratio is 0.63 and this parameter warrants further investigation in patients with brain injury. [ABSTRACT FROM AUTHOR]

Objective: To prospectively investigate the predictive value of initial intracranial pressure (ICP) for refractory intracranial hypertension and outcomes in persons with diffuse traumatic brain injury (TBI). Methods: A prospective observational study was conducted in 107 adult persons with diffuse TBI (Marshall CT Class II-IV). Initial ICP was defined as the first ICP recorded in the operating room. Refractory intracranial hypertension was defined as ICP increases to more than 30 mmHg and/or reduces in cerebral perfusion pressure to less than 60 mmHg for a period longer than 15 minutes and failure to respond to the maximum medical treatment. Baseline demographics and injury-specific data were recorded. Multiple logistic regression models were used to determine independent risk factors for refractory intracranial hypertension and unfavourable outcomes. A receiver-operating characteristic (ROC) curve was then drawn. Results: The initial ICP allowed for a better refractory intracranial hypertension prediction (ROC area = 0.868; 95% CI = 0.799-0.937) than the Marshall Classification (ROC area = 0.670; 95% CI = 0.569-0.772) or Rotterdam Classification scores (ROC area = 0.679; 95% CI = 0.577-0.780). An initial ICP value higher than 20 mmHg had 83% sensitivity and 83% specificity, whereas an initial ICP value higher than 25 mmHg had 64% sensitivity and 92% specificity for refractory intracranial hypertension. A multivariable logistic regression model showed that any 5 mmHg pressure increase in a patient with initial ICP led to 2.884-times higher odds of refractory intracranial hypertension (95% CI = 1.893-4.395; p < 0.001). Head Abbreviated Injury Scale score, initial Glasgow Coma Scale (GCS) and initial GCS motor scores were not predictive of refractory intracranial hypertension ( p > 0.05). Conclusion: For persons with diffuse TBI, the initial ICP provides great prognostic discrimination and is an independent predictor of refractory intracranial hypertension. [ABSTRACT FROM AUTHOR]

Background: Assessment of optic nerve sheath diameter (ONSD) is a non-invasive measure of intracranial pressure (ICP). However, it is not clear whether healthy individuals exhibit ONSD variation or whether factors other than ICP affect the ONSD., Purpose: To investigate whether ONSD was correlated with age, sex, height, weight, eyeball transverse diameter (ETD), or body mass index (BMI), and to develop a new diagnostic model to increase the diagnostic accuracy of intracranial hypertension (IH)., Material and Methods: A total of 145 relatively healthy adults and 40 patients with acute IH who underwent high-resolution magnetic resonance imaging (MRI) were enrolled in this study. Linear regression analyses were used to determine the relationship between ONSD and these variables. If correlations were identified, an index ONSD Δ removing variables effects was calculated. ROC analysis was used to assess the IH predictive value of ONSD Δ in terms of sensitivity and specificity., Results: In relatively healthy adults, there was a correlation between ONSD and BMI ( P  = 0.002), which can be presented as an index ONSD Δ . The ONSD Δ model better predicted IH than the ONSD model ( P  = 0.035), with a sensitivity of 70.00%, a specificity of 71.72%, and an AUC of 0.755., Conclusion: A correlation between ONSD and body mass index (BMI) was found using high-resolution MRI. This result indicates that the effects of BMI should be considered along with the ONSD during ICP monitoring. Meanwhile, the index ONSD Δ was better than the ONSD in predicting IH and could be used to obtain a more precise estimation of ICP.