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2015 | Neurologische Diagnostik | OriginalPaper | Buchkapitel

5. Neurophysiologische Diagnostik

verfasst von : Helmut Buchner, Prof. Dr., Rene Gobbelé, Prof. Dr., Peter Ringleb, Prof. Dr., Georg Karpel-Massler, Dr., Andreas Unterberg, Prof. Dr., Oliver Sakowitz, Prof. Dr., Christopher Beynon, Dr., Prof. Dr. Thorsten Steiner, Christoph Terborg, PD Dr., Emanuela Keller, Prof. Dr., Raimund Helbok, PD Dr., Christian Dohmen, Dr., Martin Seule, Dr.

Erschienen in: NeuroIntensiv

Verlag: Springer Berlin Heidelberg

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Zusammenfassung

Untersuchungsmethoden der klinischen Elektroneurophysiologie sind die Elektroenzephalographie, die Messung evozierter Potenziale, die Elektroneurographie und die Elektromyographie. In den letzten Jahrzehnten haben die Fortschritte in der Neurosonologie die Untersuchung der extra- und intrakraniellen Gefäße mit hoher Sensitivität und Spezifität ermöglicht. Weitere physiologische Parameter, die zum Monitoring und zur Überwachung des neurologischen Intensivpatienten Anwendung finden, sind die Messung des intrakraniellen Drucks, des zerebralen Perfusionsdrucks, des O2-Partialdrucks im Hirngewebe, die Nahinfrarotspektroskopie, die zerebrale Mikrodialyse sowie die Messung des zerebralen Blutflusses.

Aminoff MJ (2012) Electrodiagnosis in clinical neurology. Livingstone, New York

Bischoff C, Dengler R, Hopf HC (2008) EMG, NLG. Thieme, Stuttgart, New YorkCrossRef

Buchner H (2014) Praxisbuch Evozierte Potenziale. Thieme, Stuttgart, New YorkCrossRef

Claassen J, Taccone FS, Horn P, Holtkamp M, Stocchetti N, Oddo M (2013) Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM. Intensive Care Med 39:1337–1351PubMedCrossRef

Guérit JM, Fischer C, Facco E, Tinuper P, Murri L, Ronne-Engström E, Nuwer M (1999) Standards of clinical practice of EEG and EPs in comatose and other unresponsive states. In: Deuschl G, Eisen A (Hrsg) Recommendations for the practice of clinical neurophysiology: Guidelines of the international federation of clinical neurophysiology Electroencephalography and clinical neurophysiology, Bd. Suppl 52.

Hermans G, De Jonghe B, Bruyninckx F, Van den Berghe G (2008) Clinical review: Critical illness polyneuropathy and myopathy. Crit Care 12:238PubMedPubMedCentralCrossRef

Stöhr M, Schulte-Matter W, Quasthoff S (2014) Klinische Elektromyographie und Neurographie – Lehrbuch und Atlas. Kohlhammer, Stuttgart

Zschoke S, Hansen HC (2012) Klinische Elektroenzephalographie. Springer, BerlinCrossRef

Allendörfer J, Görtler M, von Reutern GM (2006) Prognostic relevance of ultra-early doppler sonography in acute ischaemic stroke: a prospective multicentre study. Lancet Neurol 5:835–840 (for the Neurosonology in Acute Ischemic Stroke Study Group)CrossRef

10.

Arning C, Widder B, von Reutern GM, Stiegler H, Görtler M (2010) Revison of DEGUM ultrasound criteria for grading internal carotid artery stenoses and transfer to NASCET measurement. Ultraschall Med 31:251–257PubMedCrossRef

11.

Baumgartner RW, Mattle HP, Schroth G (1999) Assessment of ≥50 % and. Stroke 30:87–92PubMedCrossRef

12.

Brandt T, Knauth M, Wildermuth S, Winter R, von Kummer R, Sartor K, Hacke W (1999) CT angiography and Doppler sonography for emergency assessment in acute basilar artery ischemia. Stroke 30:606–612PubMedCrossRef

13.

de Bray JM, Daugy J, Legrand MS, Pulci S (1998) Acute middle cerebral artery stroke and transcranial Doppler sonography. Eur J Ultrasound 7:31–36PubMedCrossRef

14.

Demchuk AM, Christou I, Wein TH, Felberg RA, Malkoff M, Grotta JC, Alexandrov AV (2000) Accuracy and criteria for localizing arterial occlusion with transcranial Doppler. J Neuroimaging 10:1–12PubMedCrossRef

15.

Droste DW, Lakemeier S, Wichter T, Stypmann J, Dittrich R, Ritter M, Moeller M, Freund M, Ringelstein EB (2002) Optimizing the technique of contrast transcranial Doppler ultrasound in the detection of right-to-left shunts. Stroke 33:2211–2216PubMedCrossRef

16.

Gahn G, Gerber J, Hallmeyer S et al (2000) Contrast enhanced transcranial colour-coded duplex sonography in stroke patients with limited bone window. AJNR 21:509–514PubMed

17.

Gahn G, von Kummer R (2001) Ultrasound in acute stroke: a review. Neuroradiology 43:702–711PubMedCrossRef

18.

Gerriets T, Seidel G, Fiss I, Modrau B, Kaps M (1999) Contrast-enhanced transcranial color-coded duplex sonography: efficiency and validity. Neurology 52:1133–1137PubMedCrossRef

19.

Gerriets T, Stolz E, Modrau B, Fiss I, Seidel G, Kaps M (1999) Sonographic monitoring of midline shift in hemispheric infarctions. Neurology 52:45–49PubMedCrossRef

20.

Görtler M, Baeumer M, Kross R, Blaser T, Lutze G, Jost S, Wallesch CW (1999) Rapid decline of cerebral microemboli of arterial origin after intravenous acetylsalicylic acid. Stroke 30:66–69CrossRef

21.

Kenton AR, Martin PJ, Abbott RJ, Moody AR (1997) Comparison of transcranial color-coded sonography and magnetic resonance angiography in acute stroke. Stroke 28:1601–1606PubMedCrossRef

22.

Klötzsch C, Janssen G, Berlit P (1994) Transesophageal echocardiography and contrast-TCD in the detection of a patent foramen ovale: experiences with 111 patients. Neurology 44:1603–1606PubMedCrossRef

23.

Mäurer M, Shambal S, Berg D, Woydt M, Hofmann E, Georgiadis D, Lindner A, Becker G (1998) Differentiation between intracerebral hemorrhage and ischemic stroke by transcranial color-coded duplex-sonography. Stroke 29:2563–2567PubMedCrossRef

24.

Mariak Z, Krejza J, Swiercz M, Kordecki K, Lewko J (2002) Accuracy of transcranial color Doppler ultrasonography in the diagnosis of middle cerebral artery spasm determined by receiver operating characteristic analysis. J Neurosurg 96:323–330PubMedCrossRef

25.

Markus HS, Droste DW, Kaps M, Larrue V, Lees KR, Siebler M, Ringelstein EB (2005) Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial. Circulation 111:2233–2240PubMedCrossRef

26.

Schulte-Altedorneburg G, Droste DW, Popa V, Wohlgemuth WA, Kellermann M, Nabavi DG, Csiba L, Ringelstein EB (2000) Visualization of the basilar artery by transcranial color-coded duplex sonography: comparison with postmortem results. Stroke 31:1123–1127PubMedCrossRef

27.

Sturzenegger M, Mattle HP, Rivoir A, Baumgartner RW (1995) Ultrasound findings in carotid artery dissection: analysis of 43 patients. Neurology 45:691–698PubMedCrossRef

28.

von Reutern GM, Goertler MW, Bornstein NM, Del Sette M, Evans DH, Hetzel A, Kaps M, Perren F, Razumovky A, von Reutern M, Shiogai T, Titianova E, Traubner P, Venketasubramanian N, Wong LK, Yasaka M, Neurosonology Research Group of the World Federation of Neurology (2012) Grading carotid stenosis using ultrasonic methods. Stroke 43:916–921CrossRef

29.

Wijdicks EF (2001) The diagnosis of brain death. N Engl J Med 344:1215–1221PubMedCrossRef

30.

Aschoff A, Steiner T (1999) Messung von Hirndruck und Perfusionsdruck. In: Schwab S, Krieger D, Müllges W, Hahmann G, Hacke W (Hrsg) Neurologische Intensivmedizin. Springer, Heidelberg, New-York, S 261–303

31.

Asgeirsson B, Grände PO et al (1994) A new therapy of post-trauma brain oedema based on haemodynamic principles for brain volume regulation. Intensive Care Med 20:260–267PubMedCrossRef

32.

Brawanski A, Gaab MR (1981) Intracranial pressure gradients in the presence of various intracranial space-occupying lesions. Advanc Neurosurg 9:355–362CrossRef

33.

Bullock MR, Chesnut RM (2007) Guidelines for the management of severe traumatic brain injury. Brain Trauma Foundation and American Association of Neurological Surgeons, New York

34.

Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W et al (2012) A trial of intracranial-pressure monitoring in traumatic brain injury. New Engl J Med 376:2471–2481CrossRef

35.

Cremer OL, van Dijk GW et al (2005) Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury. Crit Care Med 33:2207–2213PubMedCrossRef

36.

Czosnyka M, Pickard JD (2004) Monitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatry 75:813–821PubMedPubMedCentralCrossRef

37.

Grände PO (2006) „The Lund Concept” for the treatment of severe head trauma – physiological principles and clinical application. Intensive Care Med 32:1475–1484PubMedCrossRef

38.

Holloway KL, Barnes T et al (1996) Ventriculostomy Infections: The Effect of Monitoring Duration and Catheter Exchange in 584 Patients. J Neurosurg 85:419–424PubMedCrossRef

39.

Lundberg N (1960) Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Scand 36(Suppl 149):1–193

40.

Pfeifer G (1980) Über die gegenseitige Beeinflussung von intrakraniellem Druck und Körperkreislauf unter Einbeziehung der Aktivität vegetativer Nerven. Medizinische Habilitationsschrift, Universität Bonn

41.

Piek J (2006) Intrakranieller Druck – zerebraler Perfusionsdruck. In: Piek J, Unterberg A (Hrsg) Grundlagen Neurochirurgischer Intensivmedizin. Zuckschwerdt, München, Wien, New York, S 38–50

42.

Piek J, Plewe P et al (1988) Intrahemispheric gradients of brain tissue pressure in patients with brain tumours. Acta Neurochir (Wien) 93:129–135CrossRef

43.

Richard KE (1978) Long-term measuring of ventricular CSF pressure with tumors of the posterior fossa. Adv Neurosurg 5:179–187

44.

Rosner MJ, Rosner SD et al (1995) Cerebral perfusion pressure: management protocol and clinical results. J Neurosurgery 83:949–962CrossRef

45.

Sarrafzadeh AS, Smoll NR, Unterberg AW (2014) Lessons from the intracranial pressure-monitoring trial in patients with traumatic brain injury. World Neurosurg 82:E393–E395PubMedCrossRef

46.

Schwab S, Aschoff A et al (1996) The value of intracrainial pressure monitoring in acute hemispheric stroke. Neurology 47:393–398PubMedCrossRef

47.

Steiner LA, Andrews PJD (2006) Monitoring the injured brain: ICP and CBF. Br J Anaesth 97:26–38PubMedCrossRef

48.

Unterberg A, Kiening K et al (1993) Long-term observations of intracranial pressure after severe head injury. The phenomenon of secondary rise of intracranial pressure. Neurosurgery 32:17PubMedCrossRef

49.

Al-Rawi PG, Ming-Yuan T et al (2010) Hypertonic saline in patients with poor-grade subarachnoid hemorrhage improves cerebral blood flow, brain tissue oxygen, and pH. Stroke 41(1):122–128PubMedCrossRef

50.

Beppu T, Kamada K et al (2002) Change of oxygen pressure in glioblastoma tissue under various conditions. J Neurooncol 58(1):47–52PubMedCrossRef

51.

Beynon C, Kiening KL et al (2012) Brain tissue oxygen monitoring and hyperoxic treatment in patients with traumatic brain injury. J Neurotrauma 29:2109–2123PubMedCrossRef

52.

Brain Trauma Foundation et al (2007) Guidelines for the Management of Severe Traumatic Brain Injury, 3rd Edition. J Neurotrauma (24):1–106

53.

Brawanski A, Faltermeier R et al (2002) Comparison of near-infrared spectroscopy and tissue p(O2) time series in patients after severe head injury and aneurysmal subarachnoid hemorrhage. J Cereb Blood Flow Metab 22(5):605–611PubMedCrossRef

54.

Cerejo A, Silvo PA et al (2012) Intraoperative brain oxygenation monitoring and vasospasm in aneurysmal subarachnoid hemorrhage. Neurol Res 34:181–186PubMed

55.

Charbel FT, Du X et al (2000) Brain tissue PO(2), PCO(2), and pH during cerebral vasospasm. Surg Neurol 54(6):432–437 (discussion 438)PubMedCrossRef

56.

Clark JC Jr. (1956) Monitor and control of blood and tissue oxygen tension. Transaction of the Society of Art internal Organs 2:41–48

57.

Deshaies EM, Jacobsen W et al (2012) Brain tissue oxygen monitoring to assess reperfusion after intra-arterial treatment of aneurysmal subarachnoid hemorrhage-induced cerebral vasospasm: a retrospective study. Am J Neuroradiol 33:1411–1415PubMedCrossRef

58.

Dings J, Meixensberger J et al (1998) Clinical experience with 118 brain tissue oxygen partial pressure catheter probes. Neurosurgery 43(5):1082–1095PubMedCrossRef

59.

Doppenberg EM, Zauner A et al (1998) Determination of the ischemic threshold for brain oxygen tension. Acta Neurochir Suppl (Wien) 71:166–169

60.

Hartl R, Bardt TF et al (1997) Mannitol decreases ICP but does not improve brain-tissue pO₂ in severely head-injured patients with intracranial hypertension. Acta Neurochir Suppl (Wien) 70:40–42

61.

Hoelper BM, Hofmann E et al (2003) Transluminal balloon angioplasty improves brain tissue oxygenation and metabolism in severe vasospasm after aneurysmal subarachnoid hemorrhage: case report. Neurosurgery 52(4):970–974 (discussion 974–976)PubMedCrossRef

62.

Jaeger M, Schuhmann MU et al (2006) Continuous assessment of cerebrovascular autoregulation after traumatic brain injury using brain tissue oxygen pressure reactivity. Crit Care Med 34:1783–1788PubMedCrossRef

63.

Kett-White R, Hutchinson PJ et al (2002) Adverse cerebral events detected after subarachnoid hemorrhage using brain oxygen and microdialysis probes. Neurosurgery 50(6):1213–1221 (discussion 1221–1222)PubMed

64.

Kiening KL, Unterberg AW et al (1996) Monitoring of cerebral oxygenation in patients with severe head injuries: brain tissue pO₂ vs. jugular vein oxygen saturation. J Neurosurg 85:751–757PubMedCrossRef

65.

Ko SB, Choi HA et al (2011) Multimodality monitoring for cerebral perfusion pressure optimization in comatose patients with intracerebral hemorrhage. Stroke 42:3087–3092PubMedPubMedCentralCrossRef

66.

Leniger-Follert E, Lübbers DW et al (1975) Regulation of local tissue pO₂ of the brain cortex at different arterial O₂-pressures. Pflügers Archiv 359:81–95PubMedCrossRef

67.

Longhi L, Valeriani V et al (2002) Effects of hyperoxia on brain tissue oxygen tension in cerebral focal lesions. Acta Neurochir (Suppl) 81:315–317

68.

Maloney-Wilskey E, Gracias V et al (2009) Brain tissue oxygen and outcome after severe traumatic brain injury: A systematic review. Crit Care Med 37:2057–2063CrossRef

69.

Nortje J, Coles JP et al (2008) Effect of hyperoxia on regional oxygenation and metabolism after severe traumatic brain injury: Preliminary findings. Crit Care Med 36:273–282PubMedCrossRef

70.

Oddo M, Levine JM et al (2009) Effect of mannitol and hypertonic saline on cerebral oxygenation in patients with severe traumatic brain injury and refractory intracranial hypertension. J Neurol Neurosurg Psychiatry 80(8):916–920PubMedCrossRef

71.

Raabe A, Beck J et al (2005) Relative importance of hypertension compared with hypervolemia for increasing cerebral oxygenation in patients with cerebral vasospasm after subarachnoid hemorrhage. J Neurosurg 103:974–981PubMedCrossRef

72.

Reinprecht A, Greher M et al (2003) Prone position in subarachnoid hemorrhage patients with acute respiratory distress syndrome: effects on cerebral tissue oxygenation and intracranial pressure. Crit Care Med 31(6):1831–1838PubMedCrossRef

73.

Sakowitz O, Stover J et al (2007) Effects of mannitol bolus administration on intracranial pressure, cerebral extracellular metabolites, and tissue oxygenation in severely head-injured patients. J Trauma 62:292–298PubMedCrossRef

74.

Soehle M, Jaeger M et al (2003) Online assessment of brain tissue oxygen autoregulation in traumatic brain injury and subarachnoid hemorrhage. Neurol Res 25(4):411–417PubMedCrossRef

75.

Steiner T, Pilz J et al (2001) Multimodal monitoring in middle cerebral artery stroke. Stroke 32:2500–2506PubMedCrossRef

76.

Stiefel M, Spiotta A et al (2005) Reduced mortality rate in patients with severe traumatic brain injury treated with brain tissue oxygen monitoring. J Neurosurg 103:805–811PubMedCrossRef

77.

Tisdall MM, Tachtsidis I et al (2008) Increase in cerebral aerobic metabolism by normobaric hyperoxia after traumatic brain injury. J Neurosurg 109:424–432PubMedCrossRef

78.

Tolias C, Reinert M et al (2004) Normobaric hyperoxia-induced improvement in cerebral metabolism and reduction in intracranial pressure in patients with severe head injury: a prospective historical cohort-matched study. J Neurosurg 101:435–444PubMedCrossRef

79.

Unterberg AW, Kiening KL et al (1997) Multimodal monitoring in patients with head injury: evaluation of the effects of treatment on cerebral oxygenation. J Trauma 42(5 Suppl):32–37CrossRef

80.

van den Brink WA, Haitsma IA et al (1998) Brain parenchyma/pO₂ catheter interface: a histopathological study in the rat. J Neurotrauma 15(10):813–824PubMedCrossRef

81.

van Santbrink H, Maas AI et al (1996) Continuous monitoring of partial pressure of brain tissue oxygen in patients with severe head injury. Neurosurgery 38(1):21–31PubMedCrossRef

82.

Zauner A, Bullock R et al (1995) Brain oxygen, CO2, pH, and temperature monitoring: evaluation in the feline brain. Neurosurgery 37(6):1168–1177PubMedCrossRef

83.

Zauner A, Doppenberg EM et al (1997) Continuous monitoring of cerebral substrate delivery and clearance: initial experience in 24 patients with severe acute brain injuries. Neurosurgery 41(5):1082–1091 (discussion 1091–1093)PubMedCrossRef

84.

Jobsis FF (1977) Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science 198:1264–1267PubMedCrossRef

85.

Obrig H, Villringer A (2003) Beyond the visible-imaging the human brain with light. J Cereb Blood Flow Metab 23:1–18PubMedCrossRef

86.

Ohmae E, Ouchi Y, Oda M et al (2006) Cerebral hemodynamics evaluation by near-infrared time-resolved spectroscopy: correlation with simultaneous positron emission tomography measurements. Neuroimage 29:697–705PubMedCrossRef

87.

Ghosh A, Elwell C, Smith M (2012) Cerebral near-infrared spectroscopy in adults: a work in progress. Anesth Analg 115():1373–1383PubMedCrossRef

88.

Nielsen HB (2014) Systematic review of near-infrared spectroscopy determined cerebral oxygenation during non-cardiac surgery. Front Physiol 5:9CrossRef

89.

Keller E, Mudra R (2007) Measurement of cerebral blood flow with near infrared spectroscopy and indocyanine green dye dilution. Curr Med Imaging Rev 3:139–150CrossRef

90.

Murkin JM, Arango M (2009) Near-infrared spectroscopy as an index of brain and tissue oxygenation. Br J Anaesth 103(Suppl 1):i3–13PubMedCrossRef

91.

Highton D, Elwell C, Smith M (2010) Noninvasive cerebral oximetry: Is there light at the end of the tunnel? Curr Opin Anaesthesiol 23:576–581PubMedCrossRef

92.

Kirkpatrick PJ, Smielewski P, Whitfield PC, Czosnyka M, Menon D, Pickard JD (1995) An observational study of near-infrared spectroscopy during carotid endarterectomy. J Neurosurg 82:756–763PubMedCrossRef

93.

Dunham CM, Ransom KJ, Flowers LL, Siegal JD, Kohli CM (2004) Cerebral hypoxia in severely brain-injured patients is associated with admission glasgow coma scale score, computed tomographic severity, cerebral perfusion pressure, and survival. J Trauma 56:482–489 (discussion 489–491)PubMedCrossRef

94.

Al-Rawi PG, Smielewski P, Kirkpatrick PJ (2001) Evaluation of a near-infrared spectrometer (niro 300) for the detection of intracranial oxygenation changes in the adult head. Stroke 32:2492–2500PubMedCrossRef

95.

Al-Rawi PG, Kirkpatrick PJ (2006) Tissue oxygen index: Thresholds for cerebral ischemia using near-infrared spectroscopy. Stroke 37:2720–2725PubMedCrossRef

96.

Pennekamp CW, Bots ML, Kappelle LJ, Moll FL, de Borst GJ (2009) The value of near-infrared spectroscopy measured cerebral oximetry during carotid endarterectomy in perioperative stroke prevention. A review. Eur J Vasc Endovasc Surg 38:539–545PubMedCrossRef

97.

Murkin JM, Adams SJ, Novick RJ, Quantz M, Bainbridge D, Iglesias I, Cleland A, Schaefer B, Irwin B, Fox S (2007) Monitoring brain oxygen saturation during coronary bypass surgery: A randomized, prospective study. Anesth Analg 104:51–58PubMedCrossRef

98.

Slater JP, Guarino T, Stack J, Vinod K, Bustami RT, Brown JM 3rd, Rodriguez AL, Magovern CJ, Zaubler T, Freundlich K, Parr GV (2009) Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery. Ann Thorac Surg 87:36–44 (discussion 44–35)PubMedCrossRef

99.

Nagashima H, Okudera H, Kobayashi S, Iwashita T (1998) Monitoring of cerebral hemodynamics using near-infrared spectroscopy during local intraarterial thrombolysis: Case report. Surg Neurol 49:420–424PubMedCrossRef

100.

Damian MS, Schlosser R (2007) Bilateral near infrared spectroscopy in space-occupying middle cerebral artery stroke. Neurocrit Care 6:165–173PubMedCrossRef

101.

Yokose N, Sakatani K, Murata Y, Awano T, Igarashi T, Nakamura S, Hoshino T, Katayama Y (2010) Bedside monitoring of cerebral blood oxygenation and hemodynamics after aneurysmal subarachnoid hemorrhage by quantitative time-resolved near-infrared spectroscopy. World Neurosurg 73:508–513PubMedCrossRef

102.

Asim K, Gokhan E, Ozlem B, Ozcan Y, Deniz O, Kamil K, Murat Z, Aydın C, Selman Y (2014) Near infrared spectrophotometry (cerebral oximetry) in predicting the return of spontaneous circulation in out-of-hospital cardiac arrest. Am J Emerg Med 32:14–17PubMedCrossRef

103.

Ahn A, Nasir A, Malik H, D’Orazi F, Parnia S (2013) A pilot study examining the role of regional cerebral oxygen saturation monitoring as a marker of return of spontaneous circulation in shockable (VF/VT) and non-shockable (PEA/Asystole) causes of cardiac arrest. Resuscitation 84:1713–1716PubMedCrossRef

104.

Smielewski P, Czosnyka M, Pickard JD, Kirkpatrick P (1997) Clinical evaluation of near-infrared spectroscopy for testing cerebrovascular reactivity in patients with carotid artery disease. Stroke 28:331–338PubMedCrossRef

105.

Terborg C, Gora F, Weiller C, Rother J (2000) Reduced vasomotor reactivity in cerebral microangiopathy : A study with near-infrared spectroscopy and transcranial doppler sonography. Stroke 31:924–929PubMedCrossRef

106.

Terborg C, Birkner T, Schack B, Weiller C, Rother J (2003) Noninvasive monitoring of cerebral oxygenation during vasomotor reactivity tests by a new near-infrared spectroscopy device. Cerebrovasc Dis 16:36–41PubMedCrossRef

107.

Vernieri F, Silvestrini M, Tibuzzi F, Pasqualetti P, Altamura C, Passarelli F, Matteis M, Rossini PM (2006) Hemoglobin oxygen saturation as a marker of cerebral hemodynamics in carotid artery occlusion: An integrated transcranial doppler and near-infrared spectroscopy study. J Neurol 253:1459–1465PubMedCrossRef

108.

Zweifel C, Castellani G, Czosnyka M, Carrera E, Brady KM, Kirkpatrick PJ, Pickard JD, Smielewski P. Continuous assessment of cerebral autoregulation with near-infrared spectroscopy in adults after subarachnoid hemorrhage. Stroke 41: 1963–1968

109.

Keller E, Nadler A, Imhof HG, Niederer P, Roth P, Yonekawa Y (2002) New methods for monitoring cerebral oxygenation and hemodynamics in patients with subarachnoid hemorrhage. Acta Neurochir (Suppl) 82:87–92

110.

Keller E, Ishihara H, Nadler A, Niederer P, Seifert B, Yonekawa Y, Frei K (2002) Evaluation of brain toxicity following near infrared light exposure after indocyanine green dye injection. J Neurosci Methods 117:23–31PubMedCrossRef

111.

Roberts I, Fallon P, Kirkham FJ, Lloyd Thomas A, Cooper C, Maynard R, Elliot M, Edwards AD (1993) Estimation of cerebral blood flow with near infrared spectroscopy and indocyanine green. Lancet 342:1425PubMedCrossRef

112.

Kuebler WM, Sckell A, Habler O, Kleen M, Kuhnle GE, Welte M, Messmer K, Goetz AE (1998) Noninvasive measurement of regional cerebral blood flow by near-infrared spectroscopy and indocyanine green. J Cereb Blood Flow Metab 18:445–456PubMedCrossRef

113.

Wagner BP, Gertsch S, Amann RA, Pfenninger J (2003) Reproducibility of the blood flow index as noninvasive, bedside estimation of cerebral blood flow. Intensive Care Med 29:196–200PubMedCrossRef

114.

Terborg C, Bramer S, Harscher S, Simon M, Witte OW (2003) Bedside assessment of cerebral perfusion reductions in patients with acute ischemic stroke by near-infrared spectroscopy and indocyanine green. J Neurol Neurosurg Psychiatry 75:38–42

115.

Terborg C, Groschel K, Petrovitch A, Ringer T, Schnaudigel S, Witte OW, Kastrup A (2009) Noninvasive assessment of cerebral perfusion and oxygenation in acute ischemic stroke by near-infrared spectroscopy. Eur Neurol 62:338–343PubMedCrossRef

116.

Keller E, Nadler A, Alkhadi H, Kollias S, Yonekawa Y, Niederer P (2003) Noninvasive measurement of regional cerebral blood flow and regional cerebral bood volume by near infrared spectroscopy and indocynaine green dye dilution. Neuroimage 20:828–839PubMedCrossRef

117.

Steinbrink J, Wabnitz H, Obrig H, Villringer A, Rinneberg H (2001) Determining changes in nir absorption using a layered model of the human head. Phys Med Biol 46:879–896PubMedCrossRef

118.

Keller E, Froehlich J, Muroi C, Sikorski C, Muser M (2011) Neuromonitoring in intensive care: A new brain tissue probe for combined monitoring of intracranial pressure (icp) cerebral blood flow (cbf) and oxygenation. Acta Neurochir (Suppl) 110:217–220

119.

Ohmae E, Ouchi Y, Oda M, Suzuki T, Nobesawa S, Kanno T, Yoshikawa E, Futatsubashi M, Ueda Y, Okada H, Yamashita Y (2006) Cerebral hemodynamics evaluation by near-infrared time-resolved spectroscopy: Correlation with simultaneous positron emission tomography measurements. Neuroimage 29:697–705PubMedCrossRef

120.

Lee JK, Kibler KK, Benni PB, Easley RB, Czosnyka M, Smielewski P, Koehler RC, Shaffner DH, Brady KM (2009) Cerebrovascular reactivity measured by near-infrared spectroscopy. Stroke 40:1820–1826PubMedCrossRef

121.

Kakihana Y, Matsunaga A, Yasuda T, Imabayashi T, Kanmura Y, Tamura M (2008) Brain oxymetry in the operating room: Current status and future directions with particular regard to cytochrome oxidase. J Biomed Opt 13:033001PubMedCrossRef

122.

Harilall Y, Adam JK, Biccard BM, Reddi A (2014) The effect of optimising cerebral tissue oxygen saturation on markers of neurological injury during coronary artery bypass graft surgery. Heart Lung Circ 23:68–74PubMedCrossRef

123.

Bellander BM, Cantais E, Enblad P, Hutchinson P, Nordstrom CH, Robertson C et al (2004) Consensus meeting on microdialysis in neurointensive care. Intensive care med 30:2166–2169PubMedCrossRef

124.

Berger C, Schabitz WR, Georgiadis D, Steiner T, Aschoff A, Schwab S (2002) Effects of hypothermia on excitatory amino acids and metabolism in stroke patients: a microdialysis study. Stroke 33:519–524PubMedCrossRef

125.

Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N et al (2008) Intensive insulin therapy and pentastarch resuscitation in severe sepsis. New Engl J Med 358:125–139PubMedCrossRef

126.

Chen HI, Stiefel MF, Oddo M, Milby AH, Maloney-Wilensky E, Frangos S et al (2011) Detection of cerebral compromise with multimodality monitoring in patients with subarachnoid hemorrhage. Neurosurgery 69:53–63 (discussion 63)PubMedCrossRef

127.

Choi HA, Ko SB, Chen H, Gilmore E, Carpenter AM, Lee D et al (2012) Acute effects of nimodipine on cerebral vasculature and brain metabolism in high grade subarachnoid hemorrhage patients. Neurocrit care 16:363–367PubMedCrossRef

128.

Chou SH, Feske SK, Atherton J, Konigsberg RG, De Jager PL, Du R et al (2012) Early elevation of serum tumor necrosis factor-alpha is associated with poor outcome in subarachnoid hemorrhage. J Invest Med 60:1054–1058CrossRef

129.

Claassen J, Carhuapoma JR, Kreiter KT, Du EY, Connolly ES, Mayer SA (2002) Global cerebral edema after subarachnoid hemorrhage: Frequency, predictors, and impact on outcome. Stroke 33:1225–1232PubMedCrossRef

130.

Connolly ES Jr., Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT et al (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: A guideline for healthcare professionals from the american heart association/american stroke association. Stroke 43:1711–1737PubMedCrossRef

131.

Diedler J, Karpel-Massler G, Sykora M, Poli S, Sakowitz OW, Veltkamp R et al (2010) Autoregulation and brain metabolism in the perihematomal region of spontaneous intracerebral hemorrhage: An observational pilot study. J Neurol Sci 295:16–22PubMedCrossRef

132.

Dohmen C, Bosche B, Graf R, Staub F, Kracht L, Sobesky J, Neveling M, Brinker G, Heiss WD (2003) Prediction of malignant course in MCA infarction by PET and microdialysis. Stroke 34:2152–2158PubMedCrossRef

133.

Enblad P, Valtysson J, Andersson J, Lilja A, Valind S, Antoni G, Langstrom B, Hillered L, Persson L (1996) Simultaneous intracerebral microdialysis and positron emission tomography in the detection of ischemia in patients with subarachnoid hemorrhage. J Cereb Blood Flow Metab 16:637–644PubMedCrossRef

134.

Feuerstein D, Manning A, Hashemi P, Bhatia R, Fabricius M, Tolias C, Pahl C, Ervine M, Strong AJ, Boutelle MG (2010) Dynamic metabolic response to multiple spreading depolarizations in patients with acute brain injury: an online microdialysis study. J Cereb Blood Flow Metab 30:1343–1355PubMedPubMedCentralCrossRef

135.

Helbok R, Schmidt MJ, Kurtz P, Hanafy KA, Fernandez L, Stuart MR, Presciutti M, Ostapkovitch ND, Conolly ES, Lee K, Badjatia N, Mayer SA, Claassen J (2010) Systemic glucose and brain energy metabolism after subarachnoid hemorrhage. Neurocrit Care 12:317–323PubMedCrossRef

136.

Helbok R, Beer R, Chemelli A, Sohm F, Broessner G, Lackner P, Sojer M, Pfausler B, Thomé C, Schmutzhard E (2011) Multimodal neuromonitoring in a patient with aneurysmal subarachnoid hemorrhage associated with aortic coarctation. Neurocrit Care 14:433–437PubMedCrossRef

137.

Helbok R, Ko SB, Schmidt JM, Kurtz P, Fernandez L, Choi HA et al (2011) Global cerebral edema and brain metabolism after subarachnoid hemorrhage. Stroke 42:1534–1539PubMedCrossRef

138.

Helbok R, Kurtz P, Schmidt MJ, Stuart MR, Fernandez L, Connolly SE et al (2012) Effects of the neurological wake-up test on clinical examination, intracranial pressure, brain metabolism and brain tissue oxygenation in severely brain-injured patients. Crit Care 16:R226PubMedPubMedCentralCrossRef

139.

Ko SB, Choi HA, Parikh G, Helbok R, Schmidt JM, Lee K et al (2011) Multimodality monitoring for cerebral perfusion pressure optimization in comatose patients with intracerebral hemorrhage. Stroke 42:3087–3092PubMedPubMedCentralCrossRef

140.

Kurtz P, Schmidt JM, Claassen J, Carrera E, Fernandez L, Helbok R et al (2010) Anemia is associated with metabolic distress and brain tissue hypoxia after subarachnoid hemorrhage. Neurocrit care 13:10–16PubMedCrossRef

141.

Lakshmanan R, Loo JA, Drake T, Leblanc J, Ytterberg AJ, McArthur DL et al (2010) Metabolic crisis after traumatic brain injury is associated with a novel microdialysis proteome. Neurocrit care 12:324–336PubMedPubMedCentralCrossRef

142.

Marcoux J, McArthur DA, Miller C, Glenn TC, Villablanca P, Martin NA et al (2008) Persistent metabolic crisis as measured by elevated cerebral microdialysis lactate-pyruvate ratio predicts chronic frontal lobe brain atrophy after traumatic brain injury. Crit care med 36:2871–2877PubMedCrossRef

143.

Mellergard P, Aneman O, Sjogren F, Saberg C, Hillman J (2011) Differences in cerebral extracellular response of interleukin-1beta, interleukin-6, and interleukin-10 after subarachnoid hemorrhage or severe head trauma in humans. Neurosurgery 68:12–19 (discussion 19)PubMedCrossRef

144.

Miller C, Vespa PM, McArthur DL, Hirt D, Etchepare M (2009) Frameless Stereotactic Aspiration and Thrombolysis of Deep Intracerebral Hemorrhage is associated with reduced levels of extracellular cerebral glutamate and unchanged lactate pyruvate ratios. Neurocrit Care 6:22–29CrossRef

145.

Nilsson OG, Brandt L, Ungerstedt U, Saveland H (1999) Bedside detection of brain ischemia using intracerebral microdialysis: subarachnoid hemorrhage and delayed ischemic deterioration. Neurosurgery 45:1176–1184 (discussion 1184–1185)PubMedCrossRef

146.

Nordstrom CH (2003) Assessment of critical thresholds for cerebral perfusion pressure by performing bedside monitoring of cerebral energy metabolism. Neurosurg focus 15:E5PubMedCrossRef

147.

Nordstrom CH, Reinstrup P, Xu W, Gardenfors A, Ungerstedt U (2003) Assessment of the lower limit for cerebral perfusion pressure in severe head injuries by bedside monitoring of regional energy metabolism. Anesthesiology 98:809–814PubMedCrossRef

148.

Oddo M, Schmidt JM, Carrera E, Badjatia N, Connolly ES, Presciutti M et al (2008) Impact of tight glycemic control on cerebral glucose metabolism after severe brain injury: A microdialysis study. Crit Care Med 36:3233–3238PubMedCrossRef

149.

Oddo M, Milby A, Chen I, Frangos S, MacMurtrie E, Maloney-Wilensky E et al (2009) Hemoglobin concentration and cerebral metabolism in patients with aneurysmal subarachnoid hemorrhage. Stroke 40:1275–1281PubMedCrossRef

150.

Parkin M, Hopwood S, Jones DA, Hashemi P, Landolt H, Fabricius M, Lauritzen M, Boutelle MG, Strong AJ (2005) Dynamic changes in brain glucose and lactate in pericontusional areas of the human cerebral cortex, monitored with rapid sampling on-line microdialysis: relationship with depolarisation-like events. J Cereb Blood Flow Metab 25:402–413PubMedCrossRef

151.

Persson L, Valtysson J, Enblad P, Warme PE, Cesarini K, Lewen A, Hillered L (1996) Neurochemical monitoring using intracerebral microdialysis in patients with subarachnoid hemorrhage. J Neurosurg 84:606–616PubMedCrossRef

152.

Proceedings of the xiii international symposium on intracranial pressure and brain monitoring, july 22-26, 2007, san francisco, california, USA (2008) Acta neurochirurgica. (Suppl)102: 1–452

153.

Reinstrup P, Stahl N, Mellergard P, Uski T, Ungerstedt U, Nordstrom CH (2000) Intracerebral microdialysis in clinical practice: Baseline values for chemical markers during wakefulness, anesthesia, and neurosurgery. Neurosurgery 47:701–709 (discussion 709–710)PubMed

154.

Roberts DJ, Jenne CN, Leger C, Kramer AH, Gallagher CN, Todd S et al (2013) Association between the cerebral inflammatory and matrix metalloproteinase responses after severe traumatic brain injury in humans. J neurotrauma 30:1727–1736PubMedCrossRef

155.

Sarrafzadeh AS, Sakowitz OW, Kiening KL, Benndorf G, Lanksch WR, Unterberg AW (2002) Bedside microdialysis: a tool to monitor cerebral metabolism in subarachnoid hemorrhage patients? Crit Care Med 30:1062–1070PubMedCrossRef

156.

Sarrafzadeh A, Haux D, Sakowitz O, Benndorf G, Herzog H, Kuechler I, Unterberg A (2003) Acute focal neurological deficits in aneurysmal subarachnoid hemorrhage: relation of clinical course, CT findings, and metabolite abnormalities monitored with bedside microdialysis. Stroke 34:1382–1388PubMedCrossRef

157.

Schiefecker AJ, Pfausler B, Beer R, Sohm F, Sabo J, Knauseder V et al (2013) Parenteral diclofenac infusion significantly decreases brain-tissue oxygen tension in patients with poor-grade aneurysmal subarachnoid hemorrhage. Crit care (London England) 17:R88CrossRef

158.

Schmidt JM, Ko SB, Helbok R, Kurtz P, Stuart RM, Presciutti M et al (2011) Cerebral perfusion pressure thresholds for brain tissue hypoxia and metabolic crisis after poor-grade subarachnoid hemorrhage. Stroke 42:1351–1356PubMedPubMedCentralCrossRef

159.

Schulz MK, Wang LP, Tange M, Bjerre P (2000) Cerebral microdialysis monitoring: Determination of normal and ischemic cerebral metabolisms in patients with aneurysmal subarachnoid hemorrhage. J neurosurg 93:808–814PubMedCrossRef

160.

Timofeev I, Carpenter KL, Nortje J, Al-Rawi PG, O`Conell MT, Czosnyka M, Smielewski P, Pickard JD, Menon DK, Kirkpatrick PJ, Gupta AK, Hutchinson PJ (2011) Cerebral extracellular chemistry ans outcome following traumatic brain injury: a microdialysis study of 223 patients. Brain 134:484–494PubMedCrossRef

161.

van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M et al (2001) Intensive insulin therapy in critically ill patients. New Engl J Med 345:1359–1367PubMedCrossRef

162.

Wartenberg KE, Schmidt JM, Claassen J, Temes RE, Frontera JA, Ostapkovich N et al (2006) Impact of medical complications on outcome after subarachnoid hemorrhage. Crit care med 34:617–623 (quiz 624)PubMedCrossRef

163.

Zazulia AR, Videen TO, Powers WJ (2009) Transient focal increase in perihematomal glucose metabolism after acute human intracerebral hemorrhage. Stroke 40:1638–1643PubMedCrossRef

164.

Zetterling M, Hallberg L, Hillered L, Karlsson T, Enblad P, Ronne Engstrom E (2010) Brain energy metabolism in patients with spontaneous subarachnoid hemorrhage and global cerebral edema. Neurosurgery 66:1102–1110PubMedCrossRef

165.

Czosnyka M, Brady K, Reinhard M, Smielewski P, Steiner LA (2009) Monitoring of cerebrovascular autoregulation: Facts, myths, and missing links. Neurocrit care 10:373–386PubMedCrossRef

166.

Fridley J, Robertson CS, Gopinath SP (2014) Quantitative lobar cerebral blood flow for outcome prediction after traumatic brain injury. J Neurotrauma (in press)

167.

Heiss WD (1990) Pathophysiology of stroke as determined by pet. Stroke 21:2–3

168.

Hölscher T, Wilkening W, Draganski B, Meves SH, Eyding J, Voit H et al (2005) Transcranial ultrasound brain perfusion assesment with a contrast agent-specific imaging mode: Results of a two-center trial. Stroke 36:2283–2285PubMedCrossRef

169.

Jaeger M, Soehle M, Schuhmann MU, Winkler D, Meixensberger J (2005) Correlation of continuously monitored regional cerebral blood flow and brain tissue oxygen. Acta Neurochir 147:51–56 (discussion 56)PubMedCrossRef

170.

Keller E, Wietasch G, Ringleb P, Scholz M, Schwarz S, Stingele R et al (2000) Bedside monitoring of cerebral blood flow in patients with acute hemispheric stroke. Crit Care Med 28:511–516PubMedCrossRef

171.

Keller E, Nadler A, Alkadhi H, Kollias SS, Yonekawa Y, Niederer P (2003) Noninvasive measurement of regional cerebral blood flow and regional cerebral blood volume by near-infrared spectroscopy and indocyanine green dye dilution. NeuroImage 20:828–839PubMedCrossRef

172.

Keller E, Froehlich J, Baumann D, Böcklin C, Sikorski C, Seule M et al (2014) Detection of delayed cerebral ischemia (dci) in subarachnoid hemorrhage applying near infrared spectroscopy: Elimination od the extracerebral signal by transcutaneous and intraparenchymatous measurements in parallel. Acta Neurochir (Suppl) (in press)

173.

Kety SS, Schmidt CF (1945) The determination of cerebral blood flow in man by the use of nitrous oxide in low concentrations. Am J Physiol 143:53–60

174.

Kuebler WM, Sckell A, Habler O, Kleen M, Kuhnle GEH, Welte M et al (1998) Noninvasive measurement of regional cerebral blood flow by near-infrared spectroscopy and indocyanine green. J Cereb Blood Flow Metab 18:445–456PubMedCrossRef

175.

Mascia L, Andrews PJ, McKeating EG, Souter MJ, Merrick MV, Piper IR (2000) Cerebral blood flow and metabolism in severe brain injury: The role of pressure autoregulation during cerebral perfusion pressure management. Intensive care Med 26:202–205PubMedCrossRef

176.

Obrist WD, Langfitt TW, Jaggi JL, Cruz J, Gennarelli TA (1984) Cerebral blood flow and metabolism in comatose patients with acute head injury. Relationship to intracranial hypertension. J Neurosurg 61:241–253PubMedCrossRef

177.

Ohmae E, Ouchi Y, Oda M, Suzuki T, Nobesawa S, Kanno T et al (2006) Cerebral hemodynamics evaluation by near-infrared time-resolved spectroscopy: Correlation with simultaneous positron emission tomography measurements. NeuroImage 29:697–705PubMedCrossRef

178.

Olesen J, Paulson OB, Lassen NA (1971) Regional cerebral blood flow in man determined by the initial slope of the clearance of intra-arterially injected 133xe. Stroke 2:519–540PubMedCrossRef

179.

Robertson CS, Narayan RK, Gokaslan ZL, Pahwa R, Grossman RG, Caram P Jr. et al (1989) Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients. J Neurosurg 70:222–230PubMedCrossRef

180.

Schubert GA, Thome C (2008) Cerebral blood flow changes in acute subarachnoid hemorrhage. Front Biosci 13:1594–1603PubMedCrossRef

181.

Schytz HW, Wienecke T, Jensen LT, Selb J, Boas DA, Ashina M (2009) Changes in cerebral blood flow after acetazolamide: An experimental study comparing near-infrared spectroscopy and spect. Eur J Neurol 16:461–467PubMedPubMedCentralCrossRef

182.

Schytz HW, Guo S, Jensen LT, Kamar M, Nini A, Gress DR et al (2012) A new technology for detecting cerebral blood flow: A comparative study of ultrasound tagged nirs and 133xe-spect. Neurocrit Care 17:139–145PubMedCrossRef

183.

Sioutos PJ, Orozco JA, Carter LP, Weinand ME, Hamilton AJ, Williams FC (1995) Continuous regional cerebral cortical blood flow monitoring in head-injured patients. Neurosurgery 36:943–949 (discussion 949–950)PubMedCrossRef

184.

Sutherland BA, Rabie T, Buchan AM (2014) Laser doppler flowmetry to measure changes in cerebral blood flow. Methods Mol Biol 1135:237–248PubMedCrossRef

185.

Terborg C, Groschel K, Petrovitch A, Ringer T, Schnaudigel S, Witte OW et al (2009) Noninvasive assessment of cerebral perfusion and oxygenation in acute ischemic stroke by near-infrared spectroscopy. Eur Neurol 62:338–343PubMedCrossRef

186.

Vajkoczy P, Roth H, Horn P, Lucke T, Thome C, Hubner U et al (2000) Continuous monitoring of regional cerebral blood flow: Experimental and clinical validation of a novel thermal diffusion microprobe. J Neurosurg 93:265–274PubMedCrossRef

187.

Wolf S, Vajkoczy P, Dengler J, Schurer L, Horn P (2012) Drift of the bowman hemedex(r) cerebral blood flow monitor between calibration cycles. Acta Neurochir (Suppl) 114:187–190CrossRef

188.

Yonas H, Pindzola RP, Johnson DW (1996) Xenon/computed tomography cerebral blood flow and its use in clinical management. Neurosurg Clin North Am 7:605–616

Titel: Neurophysiologische Diagnostik
verfasst von: Helmut Buchner, Prof. Dr.
Rene Gobbelé, Prof. Dr.
Peter Ringleb, Prof. Dr.
Georg Karpel-Massler, Dr.
Andreas Unterberg, Prof. Dr.
Oliver Sakowitz, Prof. Dr.
Christopher Beynon, Dr.
Prof. Dr. Thorsten Steiner
Christoph Terborg, PD Dr.
Emanuela Keller, Prof. Dr.
Raimund Helbok, PD Dr.
Christian Dohmen, Dr.
Martin Seule, Dr.
Verlag: Springer Berlin Heidelberg
Buch: NeuroIntensiv
Print ISBN: 978-3-662-46499-1

Electronic ISBN: 978-3-662-46500-4

Copyright-Jahr: 2015
DOI: https://doi.org/10.1007/978-3-662-46500-4_5

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Diclofenac-Gel versus Ibuprofen bei akuten Rückenschmerzen

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