Siepen, Bernhard M. and Grubwinkler, Stephan and Wagner, Andrea and Gruber, Christine and Dickopf, Alexander and Linker, Ralf A. and Schlachetzki, Felix and Baldaranov, Dobri (2020) Neuromonitoring Using Neurosonography and Pupillometry in A Weaning and Early Neurorehabilitation Unit. JOURNAL OF NEUROIMAGING, 30 (5). pp. 631-639. ISSN 1051-2284, 1552-6569
Full text not available from this repository. (Request a copy)Abstract
BACKGROUND AND PURPOSE Long-term surveillance of intracranial pressure (ICP) in neurological/neurosurgical patients during ventilator weaning and early neurorehabilitation currently relies on clinical observation because neuroimaging is rarely readily available. In this prospective study, multimodal neurosonography and pupillometry are evaluated for follow-up monitoring. METHODS Sonographic neuromonitoring was used to noninvasively examine patients' ICP during weaning and early neurorehabilitation. It allowed assessments of third ventricle width, possible midline shift, middle cerebral artery flow velocities, and bilateral optic nerve sheath diameters. Quantitative pupillometry was used to determine pupil size and reactivity. Other neuroimaging findings, spinal tap ICP measurements, and clinical follow-up data served as controls. RESULTS Seventeen patients-11 suffering from intracranial hemorrhage, four from encephalopathies, and two from ischemic stroke-were examined for ICP changes by using neurosonography and pupillometry during a mean observation period of 21 days. In total, 354 of 980 analyses (36.1%) yielded pathological results. In 15 of 17 patients (88.2%), pathological values were found during follow-up without a clear clinical correlate. In two patients (11.8%), clinically relevant changes in ICP occurred and were identified using neurosonography. Abnormal pupillometry findings displayed a high predictive value for absent clinical improvement. CONCLUSION Multimodal neurosonography may be a noninvasive means for long-term ICP assessment, whereas pupillometry may only detect rapid ICP changes during acute neurointensive care. The study also illustrates common pitfalls in neuromonitoring in general, with large numbers of pathological albeit nonsignificant findings. Additional controlled studies should validate the influence of detected subtle changes in ICP on neurological outcome.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | OPTIC-NERVE SHEATH; INTRACRANIAL-PRESSURE; SONOGRAPHIC ASSESSMENT; MIDLINE SHIFT; NEUROLOGICAL EMERGENCY; DIAMETER; RELIABILITY; DIAGNOSTICS; STROKE; TOOL; Intracranial pressure; optic nerve sheath diameter; pupillometry; neurorehabilitation; neuromonitoring |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Neurologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 22 Mar 2021 05:44 |
| Last Modified: | 22 Mar 2021 05:44 |
| URI: | https://pred.uni-regensburg.de/id/eprint/44345 |
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