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(searched for: doi:10.3171/jns.1964.21.11.0909)
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, G. Van De Kraats, J. M. Dixon, W. P. Vandertop,
Critical Care Medicine, Volume 31, pp 584-590; https://doi.org/10.1097/01.ccm.0000050287.68977.84

Abstract:
OBJECTIVE: Mannitol is widely used in hospitals worldwide to treat patients with high intracranial pressure and/or cerebral edema. One of the mechanisms by which mannitol is thought to affect intracranial pressure is by increasing the patient's serum osmolarity, but not the osmolarity in the brain or cerebrospinal fluid. In this way, mannitol is thought to increase the osmolarity gap between the brain and the blood, which in turn leads to removal of excess water from the brain. However, relatively little is known regarding long-term effects of mannitol on osmolarity of cerebrospinal fluid. We therefore sought to determine the effects of mannitol administration on the osmolarity of cerebrospinal fluid. DESIGN: Controlled trial. SETTING: University teaching hospital. PATIENTS: Patients with severe head injury and patients with subarachnoid bleeding who required insertion of an intracranial probe. MEASUREMENTS AND MAIN RESULTS: Serum and cerebrospinal fluid osmolarity were measured before and during mannitol administration in ten patients treated with mannitol for >or=72 hrs (group 1), ten patients treated for 24 to 48 hrs (group 2), and ten controls (group 3). Serum osmolarity increased quickly in all patients receiving mannitol (groups 1 and 2), whereas remaining constant in controls. Average cerebrospinal fluid osmolarity slowly increased in all patients receiving mannitol; cerebrospinal fluid osmolarity increased from (mean +/- sd) 291.5 +/- 4.0 to 315.5 +/- 4.5 mOsm/kg after 96 hrs in group 1 (p <.01), and from 288.9 +/- 3.5 to 296.9 +/- 6.2 mOsm/kg after 48 hrs in group 2 (p <.01). Cerebrospinal fluid osmolarity remained constant in controls (p <.01 for group 1 vs. group 3 and for group 2 vs. group 3, respectively). In group 1, the gap between serum and cerebrospinal fluid osmolarity initially increased (which was the desired effect), but later decreased first to baseline values and then to below-normal levels. CONCLUSIONS: Long-term administration of mannitol can induce significant increases in cerebrospinal fluid osmolarity in patients with subarachnoid hemorrhage or severe head injury. This may be an undesirable and potentially dangerous effect. Therefore, cerebrospinal fluid osmolarity should be measured regularly in all patients receiving mannitol for longer than 24 hrs. If cerebrospinal fluid osmolarity increases, discontinuation or tapering of mannitol therapy should be considere
L B Lehman
Published: 31 March 1990
Annals of Emergency Medicine, Volume 19, pp 295-303; https://doi.org/10.1016/s0196-0644(05)82050-5

Abstract:
ICP monitoring and recording provide another important parameter in the intensive care management of many critically ill patients and have been shown to augment the clinical neurologic examination, particularly in comatose patients suffering from severe head trauma, toxic and metabolic encephalopathies, massive cerebral infarctions, and many other central nervous system insults. Once considered an experimental tool restricted exclusively to sophisticated specialty neurosurgical and neuroanesthesia intensive care units, this straightforward and rapidly evolving technology is readily available and relatively easy to apply as a bedside intensive care procedure for selected patients. Many indications of particular interest to emergency physicians are indicated. The precise role of ICP monitoring in the prehospital management of patients has not been established. At this time, the conventional treatments for presumed ICP elevations, as outlined, are the mainstays of prehospital care. ICP monitoring may have a role in more extended or lengthy interinstitutional transfers of some critically ill patients.
P. Vaagenes, P. Urdal, R. Melvoll, K. Valnes
Archives of Neurology, Volume 43, pp 357-362; https://doi.org/10.1001/archneur.1986.00520040043017

Abstract:
Creatine kinase (CK), brain CK (CKBB), lactate dehydrogenase (LD), and aspartate aminotransferase (ASAT) levels were determined in cerebrospinal fluid (CSF) obtained from 35 patients with acute stroke. In patients with transient, minor neurological disturbances, only LD levels increased; in those who remained comatose and died, the levels of all the enzymes, except ASAT, increased. Patients who remained with focal motor defects had increased CK and LD levels, while CKBB and ASAT levels were variable. In most of the CSF samples, muscle CK activity was also detectable, suggestive of a leakage from blood to CSF. The pattern of the enzyme increase could be related to the causative mechanisms for the strokes. The study suggests that CSF enzyme determinations may provide supplementary information as to the extent and severity of brain damage and the recovery potentials of selected patient groups with strokes.
Henrietta S. Bada, Sheldon B. Korones, Harold W. Kolni, Charles W. Fitch, Diana L. Ford, Hubert L. Magill, Garland D. Anderson, S.P. Wong
The American Journal of the Medical Sciences, Volume 291, pp 157-163; https://doi.org/10.1097/00000441-198603000-00003

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Robert J. Hacker, John M. Krall, John L. Fox
Published: 1 January 1983
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James F. Toole, Aneel N. Patel
Published: 1 January 1980
The publisher has not yet granted permission to display this abstract.
B. A. Polunin, V. P. Tumanov, M. Ya. Avrutskii
Bulletin of Experimental Biology and Medicine, Volume 88, pp 1484-1487; https://doi.org/10.1007/bf00830370

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Nobuyoshi Fukuhara, Masahiko Suzuki, Nagahisa Fujita, Tadao Tsubaki
Published: 1 January 1975
Acta Neuropathologica, Volume 33, pp 9-21; https://doi.org/10.1007/bf00685960

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Marc Rappel
Published: 1 June 1973
by BMJ
Postgraduate Medical Journal, Volume 49, pp 419-427; https://doi.org/10.1136/pgmj.49.572.419

Abstract:
SCOPUS: ar.jinfo:eu-repo/semantics/publishe
John L. Fox, David C. McCullough, Robert C. Green
Journal of Neurology, Neurosurgery & Psychiatry, Volume 36, pp 302-312; https://doi.org/10.1136/jnnp.36.2.302

Abstract:
Part 2 describes measurements of intracranial cerebrospinal fluid (CSF) pressure in 18 adult patients with CSF shunts, all pressure measurements being referred to a horizontal plane close to the foramina of Monro. All 18 patients had normal CSF pressure by lumbar puncture; however, in one patient an intracranial pressure of +280 mm was subsequently measured after pneumoencephalography. Twelve patients had pre-shunt CSF pressures measured intracranially: 11 ranged from +20 to +180 mm H2O and one was +280 mm H2O in the supine position. In the upright posture nine patients had values of −10 to −140 mm H2O, while three others were +60, +70, and +280 mm H2O. After CSF shunting in these 18 patients the pressures were −30 to +30 mm H2O in the supine position and −210 to −370 mm in the upright position. The effect of posture on the siphoning action of these longer shunts in the erect, adult patient is a major uncontrollable variable in maintenance of intracranial pressure after shunting. Other significant variables are reviewed. In Part 3 a concept of the hydrocephalus phenomenon is described. Emphasis is placed on the pressure differential (Pd) and force differential (Fd) causing pre-shunt ventricular enlargement and post-shunt ventricular size reduction. The site of Pd, which must be very small and not to be confused with measured ventricular pressure, P, must be at the ventricular wall.
W.James Gardner
Published: 31 January 1972
Journal of the Neurological Sciences, Volume 15, pp 1-12; https://doi.org/10.1016/0022-510x(72)90117-7

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John L. Fox, Joel L. Falik, Robert J. Shalhoub
Journal of Neurosurgery, Volume 34, pp 506-514; https://doi.org/10.3171/jns.1971.34.4.0506

Abstract:
✓ Of 80 consecutive neurosurgical patients, 23 exhibited inappropriate secretion of the antidiuretic hormone (ISADH); 11 of these patients required marked fluid restriction. Sodium concentration in the urine characteristically increased as serum values decreased. Only by following the urine sodium concentrations could the differential diagnosis of nutritional hyponatremia and ISADH be made. The role of ISADH in cerebral edema is stressed. The treatment recommended for ISADH is marked fluid restriction, whereas in nutritional hyponatremia, saline replacement is indicated.
K. Šourek, V. Trávníček
Journal of Neurosurgery, Volume 33, pp 253-259; https://doi.org/10.3171/jns.1970.33.3.0253

Abstract:
✓ Twenty-five cases of intractable epilepsy were treated by combined deep general and local extravascular brain hypothermia plus single doses of pentothal (Thiopental) or diazepam. The final local temperature of the brain in 21 patients was below 24°C, the rectal temperatures being 27° to 30°C. There was one death 6 weeks after surgery, and in two patients slight neurological deficits were found at 3 and 6 months postoperatively. In 15 patients in whom at least 1 year had elapsed since surgery, the frequency and intensity of the seizures were reduced by 50% in two, reduced to a single seizure in five, eliminated in four, and unaltered in four. The fair and excellent results included 60% of the group. In three patients improvement in behavior and emotional stability were observed postoperatively; this change was independent of the reduction of the frequency of seizures. Postoperative changes in the electroencephalogram were less frequent than changes in the frequency of seizures and also were completely independent of the clinical results.
Walter Silver, Lawrence Kuskin, Leon Goldenberg
Published: 1 January 1970
Clinical Pediatrics, Volume 9, pp 42-43; https://doi.org/10.1177/000992287000900111

Kame Ozawa, N Itada, S Kuno, Kiichiro Seta, Hajime Handa
Psychiatry and Clinical Neurosciences, Volume 20, pp 73-84; https://doi.org/10.1111/j.1440-1819.1966.tb00060.x

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