Acute Neuronal Injury: The Role of Excitotoxic Programmed

Denson G. Fujikawa 2+ within the early Eighties it used to be well-known that over the top Ca inflow, possibly via 2+ 2+ voltage-gated Ca channels, with a resultant raise in intracellular Ca, used to be linked to neuronal loss of life from cerebral ischemia, hypoglycemia, and standing epilepticus (Siejo 1981). Calcium activation of phospholipases, with arachidonic acid accumulation and its oxidation, producing unfastened radicals, used to be regarded as a possible mechanism during which neuronal harm happens. In cerebral ischemia and a pair of+ hypoglycemia, power failure was once considered the cause of over the top Ca inflow, while in prestige epilepticus it was once proposal that repetitive depolarizations have been dependable (Siejo 1981). in the meantime, John Olney chanced on that monosodium glutamate, the nutrition additive, whilst given to immature rats, used to be linked to neuronal degeneration within the arcuate nucleus of the hypothalamus, which lacks a blood-brain barrier (Olney 1969). He up this statement with a chain of observations within the Nineteen Seventies that management of kainic acid, which we now be aware of prompts the GluR5-7 subtypes of glutamate receptor, and different glutamate analogues, prompted not just post-synaptic cytoplasmic swelling, but in addition dark-cell degeneration of neurons, whilst seen by means of electron microscopy (Olney 1971; Olney et al. 1974).

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Patients who have “hypertensive ICH” are at risk for future ICH, especially if blood pressure remains uncontrolled as an outpatient 2. Perioperative care a. NPO and withhold enteral feeding after midnight before surgery b. Hold antithrombotics if possible before neurosurgical procedures in general c. Continue home medications if possible, except antithrombotics and in some cases antiypertensives d. Seizure prophylaxis is determined by the treating neurosurgeon Proposed Quality Metrics 1. Aspiration pneumonia precautions a.

Physical examination including oral cavity, chest, abdomen, and extremities for findings of trauma Diagnostic Tests 1. Imaging a. Noncontrast head CT 6 . 1 The Glasgow Coma Scale (Teasdale and Jennett 1974) Eye-opening response 4 Spontaneous 3 To speech 2 To painful stimulus 1 None Best motor response in upper limbs 6 Obeys commands 5 Localizes 4 Withdraws (normal flexion) 3 Flexes abnormally (spastic flexion) 2 Extends 1 None Verbal response 5 Oriented 4 Confused 3 Inappropriate words 2 Incomprehensive sounds 1 None Reprinted with permission of Donaghy M, Brain’s Diseases of the Nervous System: Cerebrovascular Diseases.

Aspiration pneumonia precautions a. Npo until swallow evaluation 2. Ventilator associated pneumonia (VAP) “bundle” a. Raise head of bed to 30 degrees to prevent aspiration while intubated b. daily sedation vacation c. oral decontamination/cleaning 3. DVT/PE prevention treatment a. Initial and continued sequential (pneumatic) compression devices (SCD) b. Chemical thromboprophylaxis or heparinoids can be considered if there is no vascular source of bleeding (typically not for at least first 48 hours and only with neurosurgical agreement), or if bleeding source was fixed (aneurysm completely coiled and secured) 5 2 | N E U R O L O G Y F O R T H E H O S P I TA L I S T c.

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