|
|
The use of experimental MR imaging in neurosurgery, diagnostic markers in expansive brain processes. Diagnostic markers of patients with normal pressure hydrocephalus
Vlasák, Aleš ; Bradáč, Ondřej (advisor) ; Hejčl, Aleš (referee) ; Krahulík, David (referee)
Despite decades of research of normal pressure hydrocephalus (NPH), a clear pathophysiological mechanism of the disease is sill unknown. This results in the absence of a unambiguous diagnostic biomarker. Moreover, NPH in contrast to similar neurodegenerative diseases is curable by insertion of a ventrikulo-peritoneal shunt. Now the diagnostics is based on invasive functional testing, on the contrary, imaging methods play only a supporting role. This work is processed with an effort to find a sufficiently sensitive and specific biomarker of MRI imaging using advanced analytical methods. For this reason, the structural volumetry and the phase contrast method were tested. The individual partial results of both of these modalities have already been described in the literature, but the conclusions were controversial. The main contribution of this work is the range of tested parameters and their to date untested advanced analysis - accurate automatic segmentation in volumetric study and machine learning algorithms in phase contrast study. In a volumetric study, we segmented a total of 26 structures in 74 patients (29 with diagnosed NPH, 45 without NPH). In the case of preoperative examination, we demonstrated statistically significant differences in the size of the left hippocampus, corpus callosum, left...
|
|
|
Role of Blood Biomarkers in Spontaneous Intracerebral Hemorrhage
Mračková, Jolana ; Polívka, Jiří (advisor) ; Krahulík, David (referee) ; Roubec, Martin (referee)
Role of blood biomarkers in spontaneous intracerebral hemorrhage Background: The study of blood biomarkers can offer new possibilities in diagnostics, prognostication, determination of etiology, and management of spontaneous intracerebral hemorrhage. The aim of our study was to assess the relationship between a panel of selected blood biomarkers and clinical and radiodiagnostic parameters in patients with spontaneous intracerebral hemorrhage. Primarily, the aim was to find a prognostic biomarker which could help in deciding on the optimal categorization of treatment. Patients and methods: A total of 70 patients were prospectively included in this study. The following blood biomarkers were determined: glial fibrillary acidic protein, S100B protein, matrix metalloproteinase 9, interleukin 6, interleukin 10, 25-hydroxyvitamin D, 1,25- dihydroxyvitamin D, total cholesterol, leukocyte counts, blood glucose and C-reactive protein. These were then correlated with selected clinical and radiodiagnostic parameters. Results: Relative to hematoma volume a statistically significant positive correlation was found for S100B, interleukin 10, interleukin 6 and blood glucose (S100B: ρ= 0,54, p< 0,001, IL-10: ρ= 0,43, p< 0,001, IL-6: ρ= 0,26, p= 0,027, blood glucose: ρ= 0,24, p= 0,045). Using multivariate analysis, a...
|
|
|
Early Diagnosis of the Failure of Endoscopic Third Ventriculostomy
Krejčí, Tomáš ; Řehák, Svatopluk (advisor) ; Krahulík, David (referee) ; Brichtová, Eva (referee)
Early diagnosis of the failure of endoscopic third ventricolostomy Aim of the study: The aim of the study is to determine the risk of ETV failure based on the presence or absence of radiological indications of third chamber deformation (bowing of the third chamber) on preoperative MR brain scans in patients with obstructive hydrocephalus. Additionally evaluating extend of the bowing, patients age, regression of bowing following successful ETV, etiology, degree of prematurity of newborns, persistence and character of clinical symptoms and other factors. Type of the study: Prospective clinical study. The data set and methodology: Data set comprised 157 patients with obstructive hydrocephalus operated on Neurosurgical clinic of University Hospital Ostrava between January 2008 and December 2016. The follow up duration was at least 3 months. From this cohort we were able to determine effect of bowing on ETV outcome in 135 patients. Of these patients, 70 were adults, 27 were children between 7 months and 16 years of age and 38 were infants under 6 months. From 38 infants under 6 months were 22 severe premature newborns, 9 moderately premature newborns and 7 mildly premature newborns. The extend of the bowing was determine in the range 3 - 14 mm. Results: ETV was noted as successful in 84 cases (62%). Statistical...
|
|
|
The principles of neurosurgical and intensive care liquorology
Kelbich, Petr ; Krejsek, Jan (advisor) ; Krahulík, David (referee) ; Jílek, Petr (referee)
The principles of neurosurgical and neurointensive care liquorology We observed the development of the cerebrospinal fluid (CSF) patterns in 120 patients after bleeding in the CNS (central nervous system). We used our original cytological- energetic principle to investigate 1453 samples of the CSF from these patients. The principal aim of our investigation is the detection of immunocompetitive cells in the CSF and the specification of their activation via the coefficient of energy balance (KEB). Furthermore we evaluated the numbers of erythrocytes and leucocytes in the CSF and also the catalytic activities of the aspartate aminotranspherase (AST) in the CSF as biomarkers of structural disorder of the CNS. Our goal was to evaluate a three week long development of the CSF patterns to gain more accurate information for a more effective therapy and for a better prediction of further clinical development of these patients. We confirmed that following biomarkers were unfavourable for the development of the CSF compartment and probably the CNS as a whole: higher extent of bleeding in the CNS; higher frequency of the neutrophile granulocytes in the CSF compartment; higher extent of anaerobic metabolism in the CSF compartment; higher level of the catalytic activity of the AST in the CSF; higher age...
|
|
|
Metabolic Changes of the Brain after Subarachnoid Haemorrhage
Adamkov, Jaroslav ; Náhlovský, Jiří (advisor) ; Krahulík, David (referee) ; Smrčka, Martin (referee)
Metabolic changes in the brain after subarachnoid haemorrhage. Summary The goal of the study: The goal of this study is to set concentrations of energetic metabolites in the acute phase (first 24 hours of monitoring) after subarachnoid haemorrhage (SAH) and to define the relation of these concentrations to the clinical and imaging parameters on admi-ssion and final clinical state of the patient one month after the bleeding. Throughout the period of monitoring, in all patients we observed episodes of lactate/pyruvate (L/P) ratio > 30 and their relation to actual readings of intracranial pressure (ICP) and perfuse pressure (CPP). We also monitored concentrations of glycerol in two compartments (brain interstitium and serum). Type of the study: Retrospective clinical study The set and methodology: From 2012 to 2015 we introduced a microdialysis catheter and a sensor for measuring ICP within a multimodal monitoring in 15 patients after subarachnoid bleeding. We performed this multimodal monitoring for a period of 84 days and processed in aggregate 10,080 readings. In 7 patients, together with multimodal monitoring, we also determined the serum concentration of glycerol. The onset of monitoring was always connected with obliteration of the source of bleeding either via surgery or endovascular procedure. Results:...
|
|
| |
guest ::
