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The impact of neuoropretection on brain metabolism and cognitive function during carotid endarterectomy
Mraček, Jan ; Choc, Milan (advisor) ; Chytra, Ivan (referee) ; Náhlovský, Jiří (referee)
The impact of neuroprotection on brain metabolism and cognitive function during carotid endarterectomy Introduction: Neuroprotection is a strategy that works against the biochemical and molecular manifestations that lead to ischemic brain injury. The aim of neuroprotection is to protect the hypoperfused brain region through influence upon ischemic cascade and by reducing the progress of injurious reperfusion. The development of neuroprotection has been proceeding alongside a growing understanding of brain ischemia pathophysiology. In spite of the demonstrable effects of many agents in animal models, until now none of the tested neuroprotective agents have been shown to improve the outcome in a phase III clinical trial. Objectives: Primary objective of this study was to evaluate the impact of neuroprotection, administered before carotid endarterectomy, on brain metabolism and cognitive function. The potential influence of metabolic changes within the brain on clinical outcome was assessed. The secondary objective was to assess the satisfaction of patients with the type of anesthesia administered (general or local) and to consider the preference for general or local anesthesia during similar operations in the future. Methods: A total of 35 patients underwent carotid endarterectomy with prophylactic combine...
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The significance of the S100B protein in patients with an injury to the central nervous system
Lavička, Pavel ; Choc, Milan (advisor) ; Náhlovský, Jiří (referee) ; Novák, Zdeněk (referee) ; Sameš, Martin (referee)
Inroduction: The S100B protein is a small dimeric protein which belongs to a group of calcium binding proteins. It is found in astroglial cells in the central nervous system (CNS). The S100B protein is detected, at very low concentrations, in fat tissue, muscle and bone marrow. We can measure this marker in the cerebrospinal fluid, in serum and in urine. The commercially available assay measures the sum of two different dimers (the S100A1B and S100BB) which collectively are called the S100B protein.The level of this marker increases significantly in patiens with CNS damage. Studies of patients with isolated head trauma have demostrated a correlation between serum marker level, neurological findings and outcome. In patients with polytrauma there is a problem to evaluating the initial S100B protein level with regards to CNS damage, because the S100B protein level can be affected by extracerebral sources of the S100B protein. Aim of study: The aim of our study was to evaluate the significance of the S100B protein in patiens with either isolated head trauma or polytrauma and to evaluate the significance of the initial level and the significance of dynamic monitoring of the S100B protein levels. The importace of these levels for predicting primary CNS damage, and for making a prognosis of such patiens...
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The brain infarct core delineation using computed tomography angiography source images in acute stroke patients
Rohan, Vladimír ; Choc, Milan (advisor) ; Kalvach, Pavel (referee) ; Kalita, Zbyněk (referee) ; Smrčka, Martin (referee)
Background and Purpose: Ischemic stroke is the 3rd most common cause of death and most common cause of permanent disability in developed countries. Rapid diagnostic work-up with reliable assessment of infarcted brain tissue and potentionally salvageable brain tissue is critical for acute stroke management. The first aim of this study is to asses delineation of infarct core in acute stroke patients using whole brain perfused blood volume (PBV) maps. These maps are calculated by automatic processing from computed tomography angiography source images (CTA-SI) and non-contrast computed tomography (NCCT) data. The second aim is to determine optimal quantitative threshold of PBV for infarct core identification in acute stroke setting. Material and methods: PBV maps were constructed using prototype software from NCCT and CTA-SI data in 37 acute ischemic stroke patients with angiographically proved recanalization after intravenous thrombolytic treatment. These PBV maps were automatically compared with final infarct extension on follow-up NCCT. The anatomic pixel-by-pixel correlation was assessed using Matthew's correlation coefficient (MCC) for infarct core delineation using different critical values of PBV. The optimal threshold with the best correlation was used for infarct volume computation. Minimal PBV...
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Prognostic significance of levels of brain specific biochemical markers in head injury patients
Homolková, Helena ; Choc, Milan (advisor) ; Náhlovský, Jiří (referee) ; Netuka, David (referee) ; Brichtová, Eva (referee)
OBJECTIVES: The S100B protein subgroup is a thermolabile acidic calcium-binding protein. S100B protein was first described in the central nervous system. Destruction of the nerve tissue results in S100B protein release from astrocytic glial cells and elevation of its levels in the cerebrospinal fluid. If the blood-brain barrier is also damaged, S100B gets into the systemic circulation and elevated blood levels of S100B are detected. Higher S100B serum levels in patients with head injury are predictive of possible development of secondary brain injury and the extent of permanent injury to the CNS. MATHERIAL AND METHODS: The authors present their results obtained in the group of 39 children aged 0 (newborns) to 17 years with isolated craniocerebral injury. RESULTS: Our group included 39 children aged 0-17 years. Excellent results (GOS - Glasgow outcome scale 4-5) were observed in 33 patients already at the time of transfer from our ICU to the neurological department. There was no death and the poor outcome group included only 6 children. Second GOS evaluation was performed 6 months later, when 36 children were in the GOS 4-5 group and only 3 children in the GOS 2-3 group. CONCLUSIONS: Due to high variability in S100B protein serum levels in children depending on age and gender, no correlation between...
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Decompressive craniotomy in craniocerebral injury - evaluation of outcome one year after trauma
Navrátil, Luděk ; Choc, Milan (advisor) ; Náhlovský, Jiří (referee) ; Haninec, Pavel (referee)
The study presents analysis of group of 110 patients treated for craniocerebral trauma by means of decompressive craniotomy between January 1999 and December 2003. The influence of different factors to the outcome of patient one year after injury was evaluated. Among the factors in view we included age, clinical status and its worsenig after admission, accompanying injuries, time period between injury and operation, finding during operation, intracranial pressure and postoparative complications. In addition to evaluation of particular factors to the outcome of patients we followed the correlation between various factors. Results: perimesencephalic cisterns and thickness of subdural hematoma were evaluated. In the subgroup of patients with subdural hematoma (n=63) it was found, that worsening of the outcome correlated with the thickness of subdural hematoma (p = 0.,025) and with the shift in the CT (p = 0.0001). Correlation between shift or width of cinsterns to the outcome of all patinets (n = 110) was not found. The perioperative measurement of dural gap before the duroplasty is the speciality of this work. In all patients (n = 110) the correlation between dural gap and the outcome was not found. In older patients the dural gap was lesser (p = 0.021). But in older patients the subdural hematoma was...
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Residual cognitive capacity in unconscious patients. Event related potentials and cerebral blood flow study
Holečková, Irena ; Choc, Milan (advisor) ; Polívka, Jiří (referee) ; Rektor, Ivan (referee) ; Stejskal, Lubor (referee)
UNIVERSITÉ CLAUDE BERNARD LYON 1 - LYON Ecole Doctorale Biologie Moléculaire Intégrée et Cognitive Année Universitaire 2007 - 2008 UNIVERZITA KARLOVA V PRAZE Lékařská fakulta v Plzni Vědní obor : chirurgické obory THESE EN COTTUTELLE FRANCO - TCHEQUE Irena HOLEČKOVÁ Neurochirurgické oddělení Fakultní nemocnice v Plzni Capacités cognitives chez les patients inconscients Étude des potentiels évoqués cognitifs et du débit sanguin cérébral Kognitivní kapacita u pacientů s poruchou vědomí Studie kognitivních evokovaných potenciálů a mozkového krevního průtoku Cognitive capacity in unconscious patients Event related potentials and cerebral blood flow study 2008 Ce travail de thèse a reçu le soutien financier de l'Ambassade de France en République Tchèque L'ensemble des travaux a été réalisé dans le Service de Neurophysiologie Clinique et Epileptologie de l'Hôpital Neurologique de Lyon, au sein de l'équipe de l' Unité INSERM 821 et au sein de CERMEP-imagerie du vivant de Lyon, France. Remerciements Le mot remerciement s'avère insuffisant pour exprimer ma reconnaissance envers Madame Catherine Fischer, Chargée de recherche, pour avoir diriger ce travail. Sa compétence, ses conseils ont été essentiels à la réalisation de cette thèse. Je vous remercie de m'avoir «ouvert les oreilles» au domaine passionnant des...
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The correlation of intracranial pressure and next investigative parameters at the cerebral contusion
Škúci, Ivan ; Choc, Milan (advisor) ; Novák, Zdeněk (referee) ; Smrčka, Martin (referee)
Patients with a brain injury must overcome a central neurological insult and a systematic metabolic response. The systematic response includes hypermetabolism, hypercatabolism, altered vascular permeability, increased hormone and cytokine release, altered gastric emptying, altered mineral metabolism and altered immune status. This response may initiate mechanisms which lead to secondary brain injury and may adversely affect the function of other organs. Last two decades have improved our knowledge of pathophysiology in patients with primary and secondary brain injury including traumatic contusions. In a moment of injury, primary brain injury which is traumatic contusion can not be therapeutically prevented it can only have a preventive effect. Secondary brain injury can be therapeutically affected although both types of injuries have common pathophysiological signs of disturbed metabolism on cells and subcellular level. Research methods based on molecular biology opens a new zone of research reaction of central neurological system for trauma or ischemia with effort to get involved immediately at the beginning of developing adverse pathophysiological cascade leading to a death of neurotic cell. The brain contusion is a primary centre of brain injury with anatomic changes which can be graphically proved. In...
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Cervical spondylotic myelopathy: development of clinical symptoms and surgical management
Štěpánek, David ; Choc, Milan (advisor) ; Suchomel, Petr (referee) ; Ostrý, Svatopluk (referee)
Based on contemporary theoretical knowledge in this prospective study we outline the relationship between a chosen surgical approach (anterior or posterior approach) as it relates to the localization of spinal cord lesion (anterior or posterior spinal pathways) assessed by the use of evoked potentials (SEP, MEP) and the effect of this approach on the postoperative state of patients with cervical spondylotic myelopathy. Furthermore we evaluate clinical outcome of these patients according to several aspects of their MRI and X-ray findings. The study, from 2006 to 2010, comprised 65 patients with clinical signs of cervical myelopathy. These patients had been indicated for surgery, which subsequently was performed by using either the front (anterior - a) or back (posterior - p) approach. The patients were assessed using Nurick and mJOA scores before surgery, then at 12 months, and finally 24 months after surgery. In addition, they were preoperatively examined with a battery of evoked potentials (EP) - somatosensory evoked potential (SEP) and motor evoked potential (MEP) tests. Based on EP, principal spinal cord disability was determined: A - anterior (maximum changes in MEP), P - posterior - maximum change in SEP). The entire group was, on the basis of EP partitioning and the surgical approach used, divided...
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Cervical spondylotic myelopathy: development of clinical symptoms and surgical management
Štěpánek, David ; Choc, Milan (advisor) ; Suchomel, Petr (referee) ; Ostrý, Svatopluk (referee)
Based on contemporary theoretical knowledge in this prospective study we outline the relationship between a chosen surgical approach (anterior or posterior approach) as it relates to the localization of spinal cord lesion (anterior or posterior spinal pathways) assessed by the use of evoked potentials (SEP, MEP) and the effect of this approach on the postoperative state of patients with cervical spondylotic myelopathy. Furthermore we evaluate clinical outcome of these patients according to several aspects of their MRI and X-ray findings. The study, from 2006 to 2010, comprised 65 patients with clinical signs of cervical myelopathy. These patients had been indicated for surgery, which subsequently was performed by using either the front (anterior - a) or back (posterior - p) approach. The patients were assessed using Nurick and mJOA scores before surgery, then at 12 months, and finally 24 months after surgery. In addition, they were preoperatively examined with a battery of evoked potentials (EP) - somatosensory evoked potential (SEP) and motor evoked potential (MEP) tests. Based on EP, principal spinal cord disability was determined: A - anterior (maximum changes in MEP), P - posterior - maximum change in SEP). The entire group was, on the basis of EP partitioning and the surgical approach used, divided...
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Prognostic significance of levels of brain specific biochemical markers in head injury patients
Homolková, Helena ; Choc, Milan (advisor) ; Náhlovský, Jiří (referee) ; Netuka, David (referee) ; Brichtová, Eva (referee)
OBJECTIVES: The S100B protein subgroup is a thermolabile acidic calcium-binding protein. S100B protein was first described in the central nervous system. Destruction of the nerve tissue results in S100B protein release from astrocytic glial cells and elevation of its levels in the cerebrospinal fluid. If the blood-brain barrier is also damaged, S100B gets into the systemic circulation and elevated blood levels of S100B are detected. Higher S100B serum levels in patients with head injury are predictive of possible development of secondary brain injury and the extent of permanent injury to the CNS. MATHERIAL AND METHODS: The authors present their results obtained in the group of 39 children aged 0 (newborns) to 17 years with isolated craniocerebral injury. RESULTS: Our group included 39 children aged 0-17 years. Excellent results (GOS - Glasgow outcome scale 4-5) were observed in 33 patients already at the time of transfer from our ICU to the neurological department. There was no death and the poor outcome group included only 6 children. Second GOS evaluation was performed 6 months later, when 36 children were in the GOS 4-5 group and only 3 children in the GOS 2-3 group. CONCLUSIONS: Due to high variability in S100B protein serum levels in children depending on age and gender, no correlation between...
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