Invasive Multimodal Online Monitoring in Severe Stroke Patients

  • T. Steiner
  • F. Meisel
Conference paper


‘Malignant’ stroke is one of the most severe and disabling diseases in neurology. It is defined as an acute stroke greater than two thirds of the territory of the middle cerebral artery (MCA) and progressive neurologic symptoms. About 10% of these patients develop sudden and massive hemispheric edema within 2 to 5 days after the onset of symptoms [1, 2]. Edema formation, followed by increased intracranial pressure (ICP) and mass shifts/herniation is a continuous, dynamic process. Therefore, close surveillance of the patient and continuous monitoring is of utmost im ortance.


Cerebral Perfusion Pressure Severe Head Injury Multimodal Monitoring Transtentorial Herniation Middle Cerebral Artery Infarction 
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  1. 1.
    Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R (1996) “Malignant” middle cerebral artery territory infarction. Arch Neurol 53:309-315Google Scholar
  2. 2.
    Berrouschot J, Sterker M, Bettin S, Köster J, Schneider D (1998) Mortality of space-occupying (“Malignant”) middle cerebral artery infarction under conservative intensive care. Intensive Care Med 24: 620 - 623PubMedCrossRefGoogle Scholar
  3. 3.
    Rieke K, Schwab S, Krieger D, et al (1995) Decompressive surgery in space occupying hemispheric infarction: Results of an open, prospective trial. Grit Care Med 23: 1576-1587Google Scholar
  4. 4.
    Schwab S, Steiner T, Aschoff A, et al (1998) Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke 29: 1888 - 1893PubMedCrossRefGoogle Scholar
  5. 5.
    Schwab S, Schwarz S, Spranger M, Keller E, Bertram M, Hacke W (1998) Moderate hypothermia in the treatment of patients with severe middle cerebral artery infarction. Stroke 29: 2461 - 2466PubMedCrossRefGoogle Scholar
  6. 6.
    Bullock R, Chesnut RM, Clifton G, et al (1995) Guidelines for the Management of Severe Head Injury. The Brain Trauma Foundation, New YorkGoogle Scholar
  7. 7.
    Rosner MJ, Rosner SD, Johnson AH (1995) Cerebral perfusion pressure: management protocol and clinical results. J Neurosurg 83: 949 - 962PubMedCrossRefGoogle Scholar
  8. 8.
    Unterberg AW, Kiening KL, Härtl R, Bardt T, Sarrafzadeh AS, Lanksch WR (1997) Multimodal monitoring in patients with severe head injury: evaluation of the effect of treatment on cerebral oxygenation. J Trauma 42: S32 - S37PubMedCrossRefGoogle Scholar
  9. 9.
    Sheinberg M, Kanter MJ, Robertson CS, Contant CF, Narayan RK, Grossman RG (1992) Continuous monitoring of jugular venous oxygen saturation in head injured patients. J Neurosurg 76: 212 - 217PubMedCrossRefGoogle Scholar
  10. 10.
    Robertson CS, Narayan RK, Gokoslan ZL, et al (1989) Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients. J Neurosurg 70: 222 - 230PubMedCrossRefGoogle Scholar
  11. 11.
    Maas AIR, Fleckenstein W, de Jong DA, Wolf M 1993 ) Effect of increased ICP and decreased cerebral perfusion pressure on brain tissue and cerebrospinal fluid oxygen tension. In: Avezaat CIJ, van Eijndhoven JHM, Maas AIR, Tans JTJ (eds) Intracranial Pressure VIII. Springer, Berlin, pp 233 - 237CrossRefGoogle Scholar
  12. 12.
    Maas AIR, Fleckenstein W, de Jong DA, Santbrink H (1993) Monitoring cerebral oxygenation: experimental studies and preliminary clinical results of continuous monitoring of cerebrospinal fluid and brain tissue tension. Acta Neurochir 59 (suppl): 50 - 57Google Scholar
  13. 13.
    Dings J, Jager A, Meixensberger J, Roosen K (1998) Brain tissue P02 and outcome after severe head injury. Neurol Res 20: S71 - S75PubMedGoogle Scholar
  14. 14.
    Steiner T, Pilz J, Schellinger P, et al (2001) Multimodal online monitoring in middle cerebral artery territory stroke. Stroke 32: 2500 - 2506PubMedCrossRefGoogle Scholar
  15. 15.
    Meixensberger J, Dings J, Kuhnigk H, Roosen K (1993) Studies of tissue p02 in normal and pathological human brain tissue. Acta Neurochir 59 (suppl): 58 - 63Google Scholar
  16. 16.
    van Santbrink H, Maas AI, Avezaat CJ (1996) Continuous monitoring of partial pressure of brain tissue oxygen in patients with severe head injury. Neurosurgery 38: 21 - 31PubMedCrossRefGoogle Scholar
  17. 17.
    Sahuquillo J, Poca MA, Arribas M, Garnacho A, Rubio E (1999) Interhemispheric supratentorial intracranial pressure gradients in head-injured patients: are they clinically important? J Neurosurg 90: 16 - 26PubMedCrossRefGoogle Scholar
  18. 18.
    Chambers IR, Kane PJ, Signorini DF, Jenkins A, Mendelow AD (1998) Bilateral ICP monitoring: its importance in detecting the severity of secondary insults. Acta Neurochir 71 (suppl): 42 - 43Google Scholar
  19. 19.
    Aschoff A, Steiner T (1999) Messung von Hirndruck and Perfusionsdruck. In: Schwab S, Erbguth F, Haman G, Hacke W (eds) Neurologische Intensivmedizin. Springer, Heidelberg, pp 271 - 303CrossRefGoogle Scholar
  20. 20.
    Stolz E, Gerriets T, Fiss I, Babacan SS, Seidel G, Kaps M (1999) Comparison of transcranial color-coded duplex sonography and cranial CT measurements for determining third ventricle midline shift in spaceoccupying stroke. Am J Neuroradiol 20: 1567 - 1571PubMedGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2003

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  • T. Steiner
  • F. Meisel

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