| Background and purpose: Increased intracranial pressure and cerebral edema arethe common complications of neurological diseases and other systemic diseases, andmay affect cerebral perfusion, ischemia and secondary brain injury. At present, theclinical diagnosis of increaesd intracranial pressure or cerebral edema is mainly basedon clinical manifestations, fundus examination, CT or MRI imaging and lumbarpuncture as well as invasive or non-invasive intracranial pressure monitoring.Non-invasive cerebral edema monitoring is a new technique via bioelectrical impedancetechnology in human brain tissue. This method is simple, non-invasive and dynamicmonitoring of intracranial pressure, and can be directly obtained electrical impedanceresponse of cerebral edema situation disturbance coefficient.With the dynamic non-invasive brain edema monitor produced by ChongqingBORN-BE company, the present study will monitor the cerebral edema in the patientswith increased intracranial pressure (including cerebral infarction, cerebral hemorrhage,hydrocephalus, encephalitis and various types of brain disease and headache, etc.) inorder to explore the relationship of cerebral electronic impedance perturbationcoefficient with various neurological diseases and pathophysiological situationsincluding the relationship between time of onset and disease duration, lesion locationand volume, lumbar puncture and cerebrospinal fluid pressure, etc. evaluationnon-invasive monitor of cerebral edema in the neurological intensive care practicalityand effectiveness, and the clinical value.Subjects and Methods: The total of132inpatients and outpatients recruited inDepartment of Neurology, the General Hospital of Shenyang Military Region, from July2010to February2012, of those85cases with cerebral infarction,48males and37females in age from40to78years with an average age of59±9.3years, in line with the Chinese Medical Association1995revised standard of the Fourth NationalConference of cerebrovascular disease. All stroke cases do not include lacunarinfarction. Eight cases were intracerebral hemorrhage (6males and2females, age36-72years, mean age55±14.5years old) in line with the revised standard of theChinese Medical Association Fourth National Cerebrovascular Diseases Conference1995, GCS score>8points, all to take a conservative treatment, including2cases withbasal ganglia hemorrhage,2cases with thalamic hemorrhage ruptured into the ventricle,3cases with basal ganglia hemorrhage broken into ventricles, and one cases withcerebellar hemorrhage. Initial hematoma volumes were6~62ml with an average of39.14±8.71ml. The other cases included12cases of viral encephalitis (7males and5females, average age38±8.3years),10cases of encephalopathy,5cases with whitematter lesions and5cases of metabolic encephalopathy (6males and4females, averageage42±8.7years),10cases of headache (5males and5females, mean age32±9.4years), and8patients with hydrocephalus (3males and5females, average age35±3.5years old). The volumes of cerebral infarction and cerebral hemorrhage weremeasured based on CT or MRI examination. The correlation analysis was carried outbetween the calculated volumes and the measured cerebral electric impedance (CEI)values. The intracranial pressures were determined by lumbar puncture and thecorrelation between the cerebrospinal fluid pressure values and measured CEI values.Results:1. The CEI values were determined in132patients with different neurologicaldiseases, the increaesed CEI rates were66.0%in cerebral infarction,50%cerebralhemorrhage,63.6%viral encephalitis70%encephalopathies,70%headache, and37.5%hydrocephalus.2. The lumbar puncture pressures and the CEI values in37cases were measuredand their correlation was analyzed. The results showed the linear correlation betweenlumbar puncture pressures and the CEI values with an equation: y=6.48x+78.28(y onbehalf of the lumbar puncture pressure, x is the corresponding CEI values, r=0.654, p<0.05, n=37).3. Cerebral infarction: the CEI values were gradually increased after the onset, andreached a peak4to7days after, and then gradually recovered. The CEI values in theinfarction side were higher than the side contralateral to infarction during4to7daysafter cerebral infarction with CEI values of13.59±3.10, significantly higher than thatof10.86±2.14at1to3days after the onset, and also higher than the CEI values of11.18 ±2.38after7days (p<0.05). The CEI values in the infarction side were also higher thanthe side contralateral to infarction (11.53±3.44, p <0.05). Cerebral infarction indifferent parts, the CEI abnormal rate was different. The cerebral cortex infarction andbasal ganglia infarction abnormal rates were85.6%and74.5%, while the abnormalbrain stem and cerebellar infarction was only18.8%. Results suggested that the CEIabnormal rate is higher when the infarct is more close to the cortex. In other words,non-invasive cerebral edema monitor, the sensitivity of lesion edema on the screen ismuch better than the lesions. For cerebral infarction patients, the CEI of infarction sideand the infarct volume was positively related to the straight line equation: y=10.9x-24.653(n=65, r=0.552, P <0.01).4. Cerebral hemorrhage: hematoma cerebral hemisphere CEI values been measuredfor those periods of1to3days after intracerebral hemorrhage,4to7days and morethan7days, they were11.56±2.34,12.98±2.60and9.54±1.98, hematomacontralateral cerebral hemisphere CEI values were9.45±2.23,10.01±2.54and8.04±1.78.1to3days and4to7days after intracerebral hemorrhage, the impedance valuesbetween the hematoma side and the hematoma contralateral cerebral hemisphere weresignificant difference (p <0.01). Non-invasive monitoring20cases with the cerebraledema monitor, correlation analysis carried out between the obtained CEI values andthe hematoma volume, with P>0.05. Based on the bleeding with or without break intothe ventricle,40%with intraventricular hemorrhage, intraventricular hemorrhage66.7%.5.11patients of viral encephalitis, non-invasive cerebral edema monitoring15cases, a linear relationship between the lumbar puncture pressure and the measuredelectrical impedance values, the straight line equation was Y=8.78x+56.9(Y: lumbarpuncture pressure, x: corresponds to the CEI values), p <0.01, r=0.634.6. Various encephalopathy CEI values were higher than normal, bilateral CEIvalues were14.18±2.79and14.17±2.98, P>0.05, no statistical difference.7.10cases of headache patients, the CEI values were higher than normal, the CEIvalue of individual patients up to12or more. Two cases of lumbar puncture, andlumbar puncture CSF pressure in the normal range, increased the CEI mechanism is notclear.8. With different ages, gender, the monitored CEI values were no significantdifferences (P>0.05). Conclusion:1. Non-invasive cerebral electric impedance detection could be more sensitive toreflect the intracranial pressure. CEI values were positively correlated with the lumbarpuncture pressure. The higher the CEI values the higher the lumbar puncture pressure.⒉Non-invasive in the cerebral electric impedance detection can be more sensitiveto the edema of cerebral infarction and peri-hematoma edema. The CEI values are moresensitive to the lesions in cerebral hemispheres.⒊Non-invasive cerebral electric impedance detection is a simple andnoninvasive method, being able to make a preliminary judgment for the extents of thecerebral edema and increased intracranial pressure in a variety of brain diseases(ischemic, bleeding, poisoning, injury, inflammation, etc.). It is helpful to guidingneurological practice. |
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