1,721,180 research outputs found
Osmotherapy for elevated intracranial pressure - A critical reappraisal
No full textThe administration of osmotic agents is one of the principal strategies to lower elevated intracranial pressure (ICP) and to increase cerebral perfusion pressure. Of the 3 osmotic agents frequently used (mannitol, glycerol and sorbitol), each has characteristic advantages and disadvantages. In addition to renal filtration, sorbitol [elimination half-life (t1/2 beta) approximately 1 h] and glycerol (t1/2 beta 0.2 to 1 h) are metabolised, mainly by the liver. The risk of these compounds accumulating in patients with renal insufficiency is low. However, both compounds frequently affect glucose metabolism, leading to an increase in the serum glucose concentration. Mannitol:is almost exclusively renally filtered and possesses the slowest elimination from serum (t1/2 beta 2 to 4 h). The t1/2 beta of mannitol is markedly increased in patients with renal insufficiency, but it does not interfere with glucose metabolism. Entry into the cerebrospinal fluid (CSF) is highest with glycerol [CSF : serum ratio of the areas under the concentration-time curves (AUC(CSF):AUC(s)) approximate to 0.25], intermediate with mannitol (AUC(CSF): AUC(s) approximate to 0.15) and lowest with sorbitol (AUC(CSF): AUC(s) approximate to 0.10). The elimination of all osmotic agents from the CSF compartment is substantially slower than from serum. During the elimination phase, the CSF-to-serum osmotic gradient is temporarily reversed. This is one cause of the paradoxical rise of ICP above the pretreatment level sometimes observed with osmotherapeutics. The ability of mannitol, glycerol and sorbitol to lower elevated ICP has been extensively documented. However, whether the use of osmotic agents, particularly with repeated application, improves outcome remains unproven. Therefore, these agents should only be used to treat manifest elevations of ICP, not for prophylaxis of brain oedema
Cerebrospinal Fluid Diagnostics for Neuroinfectious Diseases
No full textCerebrospinal fluid analysis is of prime importance to establish an early diagnosis of central nervous system infections. Beside the basic diagnostics containing CSF white cell count, lactate concentration and protein analysis, the targeted search for agents of bacterial, viral or fungal CNS infectious diseases is essential. Decisive methods are bacterial and fungal staining techniques, microbiological culture methods, nucleic acid amplification and antigen detection methods or indirect identification of pathogens by serologic testings including the determination of pathogen-specific intrathecal immunoglobulin synthesis. Besides imparting basic principles of cerebrospinal fluid analysis, this article focuses on special aspects of detection of infectious agents. Well-directed questions and a close communication between clinician and laboratory allow optimal diagnostic analysis for successful confirmation of the diagnosis and for optimal treatment of the patient
Therapy of bacterial meningitis
No full textUsually, purulent meningitis is an acute bacterial disease. For more than fifty years, antibiotic chemotherapy is widely available. However, the course of bacterial meningitis remains lethal in more than 20% of affected adult patients. Survivors often suffer from neurological and neuropsychological sequelae. The following article provides an overview of the current therapeutical concepts for community acquired bacterial meningitis in adults. For the treatment of purulent meningitis in Germany, we recommend ampicillin and a third-generation cephalosporin as initial antibiotic therapy. A recent study demonstrated a reduction of mortality and neurological sequelae with adjuvant dexamethasone therapy
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