Functional neurologic recovery in two dogs diagnosed with severe luxation of the vertebral column

Traumatic injuries to the vertebral column, spinal cord, and cauda equina nerve roots occur frequently in human and veterinary medicine and lead to devastating consequences. Complications include partial or complete loss of motor, sensory, and visceral functions, which are among the main causes of euthanasia in dogs. The present case report describes neurological functional recovery in two dogs that were treated surgically for severe spinal fracture and vertebral luxation. In the first case, a stray, mixed breed puppy was diagnosed with thoracolumbar syndrome and Schiff-Scherrington posture, as well as a T13 caudal epiphyseal fracture with 100% luxation between vertebrae T13 and L1; despite these injuries, the animal did show deep pain sensation in the pelvic limbs. Decompression through hemilaminectomy and spinal stabilization with vertebral body pins and bone cement were performed, and the treatment was supplemented with physiotherapy and acupuncture. In the second case, a mixed breed dog was diagnosed with a vertebral fracture and severe luxation between L6 and L7 after a vehicular trauma, but maintained nociception and perineal reflex. Surgical stabilization of the spine was performed using a modified dorsal segmental fixation technique Both patients showed significant recovery of neurological function. Complete luxation of the spinal canal observed radiographically does not mean a poor prognosis, and in some cases, motor, sensory, and visceral functions all have the potential for recovery. In the first case the determining factor for good prognosis was the presence of deep pain perception, and in the second case the prognosis was determined by the presence of sensitivity and anal sphincter tone during the initial neurological examination.

Impactos do manejo de um sistema plantio direto no crescimento e produtividade do arroz de terras altas e feijão de inverno em sucessão e nos atributos do solo

Pós-graduação em Agronomia - FEIS

Spontaneous intracerebral hemorrhage treated by neuroendoscopy: technical note

Spontaneous intracerebral hemorrhage (SICH) is responsible for 10%-15% of the acute stroke. Hematoma or the occlusion of cerebrospinal fluid (CSF) flow by ventricular clotting can result in obstructive hydrocephalus, increasing intracranial pressure, which needs urgent decompression. We report our results of management of spontaneous deep cerebral hematoma by endoscopic approach.

Predicting dysthyroid optic neuropathy using computed tomography volumetric analyses of orbital structures

OBJECTIVE: To evaluate the ability of orbital apex crowding volume measurements calculated with multidetector-computed tomography to detect dysthyroid optic neuropathy. METHODS: Ninety-three patients with Graves' orbitopathy were studied prospectively. All of the patients underwent a complete neuro-ophthalmic examination and computed tomography scanning. Volumetric measurements were calculated from axial and coronal contiguous sections using a dedicated workstation. Orbital fat and muscle volume were estimated on the basis of their attenuation values (in Hounsfield units) using measurements from the anterior orbital rim to the optic foramen. Two indexes of orbital muscle crowding were calculated: i) the volumetric crowding index, which is the ratio between soft tissue (mainly extraocular muscles) and orbital fat volume and is based on axial scans of the entire orbit; and ii) the volumetric orbital apex crowding index, which is the ratio between the extraocular muscles and orbital fat volume and is based on coronal scans of the orbital apex. Two groups of orbits (with and without dysthyroid optic neuropathy) were compared. RESULTS: One hundred and two orbits of 61 patients with Graves' orbitopathy met the inclusion criteria and were analyzed. Forty-one orbits were diagnosed with Graves' orbitopathy, and 61 orbits did not have optic neuropathy. The two groups of orbits differed significantly with regard to both of the volumetric indexes (p<0.001). Although both indexes had good discrimination ability, the volumetric orbital apex crowding index yielded the best results with 92% sensitivity, 86% specificity, 81%/94% positive/negative predictive value and 88% accuracy at a cutoff of 4.14. CONCLUSION: This study found that the orbital volumetric crowding index was a more effective predictor of dysthyroid optic neuropathy than previously described computed tomography indexes were.

Decompressive craniectomy and cerebral blood flow regulation in head injured patients: A case studied by perfusion CT

Previous studies have reported increased cerebral blood flow (CBF) velocity after decompressive craniectomy in traumatic brain injury (TBI) patients. A 27-year-old man presented with clinical and tomographic signs of cerebral herniation secondary to TBI. Prior to decompressive craniectomy, hemodynamic study by perfusion computed tomography (CT) indicated diffuse cerebral hyperperfusion. Following surgical decompression, the patient recovered neurologically and perfusion CT disclosed a decrease in the intensity of cerebral perfusion. The patient's blood pressure levels were similar at both pre- and postoperative perfusion CT examinations. This finding provides indirect evidence that decompressive craniectomy may improve mechanisms of CBF regulation in TBI, providing pathophysiological insights in the cerebral hemodynamics of TBI patients. This is the first report analyzing the hemodynamic changes through perfusion CT (PCT) in a patient with decompressive craniotomy due to TBI. (C) 2012 Elsevier Masson SAS. All rights reserved.

Conservative Management of a Large Keratocystic Odontogenic Tumor in the Maxilla

Keratocystic odontogenic tumor is characterized by high recurrence rates. Conservative or aggressive management has been suggested as a method of treatment. Decompression is a conservative treatment that has been used in the treatment of large odontogenic cysts. The authors report a case of a 14-year-old patient with a keratocystic odontogenic tumor located in the right maxilla, which was treated by decompression followed by enucleation with curettage. The lesion did not recur on follow-up for 3 years after the enucleation surgery.

Surgical management of dentigerous cyst and keratocystic odontogenic tumor in children: a conservative approach and 7-year follow-up

Dentigerous cyst (DC) is one of the most common odontogenic cysts of the jaws and rarely recurs. On the other hand, keratocystic odontogenic tumor (KCOT), formerly known as odontogenic keratocyst (OKC), is considered a benign unicystic or multicystic intraosseous neoplasm and one of the most aggressive odontogenic lesions presenting relatively high recurrence rate and a tendency to invade adjacent tissue. Two cases of these odontogenic lesions occurring in children are presented. They were very similar in clinical and radiographic characteristics, and both were treated by marsupialization. The treatment was chosen in order to preserve the associated permanent teeth with complementary orthodontic treatment to direct eruption of the associated permanent teeth. At 7-years of follow-up, none of the cases showed recurrence.

Surgical treatment of globe subluxation in the active phase of the myogenic type of Graves orbitopathy: case reports

The purpose of the present article is to present and discuss two cases of globe subluxation in the active phase of myogenic Graves' orbitopathy and to evaluate the prevalence of this phenomenon. Two patients with the myogenic variant of Graves' orbitopathy that had being treated with oral and intravenous steroid pulses developed globe subluxation. Both had to have urgent eyelid and orbital decompression. After these observations, we reviewed the medical records of a sample of 284 patients (482 orbits) who had had orbital decompression at our Institution from 1992 to 2010, with a search for cases presenting severe proptosis or globe subluxation in the active phase of myogenic Graves' orbitopathy. No patient had to have decompression for globe subluxation in the active phase of Graves' orbitopathy. The prevalence of this event as an indication for surgery in the myogenic variant of Graves' orbitopathy was therefore 0.7% (2/284) or even less. The combination of lowering the upper eyelid and orbital decompression had a dramatic therapeutic effect on these patients despite the presence of intense inflammatory signs in the orbits. In conclusion, patients affected with the myogenic variant of Graves' orbitopathy may develop globe subluxation. Urgent surgical treatments should not be postponed despite the presence of active inflammation.

Redundant nerve roots of the cauda equina: review of the literature

In imaging diagnosis, redundant nerve roots of the cauda equina are characterized by the presence of elongated, enlarged and tortuous nerve roots in close relationship with a high-grade lumbar spinal canal stenosis. This is not an independent entity, but it is believed to be a consequence of the chronic compression at the level of the lumbar canal stenosis and thus may be part of the natural history of lumbar spinal stenosis. The present paper is aimed at reviewing the histopathological, electrophysiological and imaging findings, particularly at magnetic resonance imaging, as well as the clinical meaning of this entity. As the current assessment of canal stenosis and root compression is preferably performed by means of magnetic resonance imaging, this is the imaging method by which the condition is identified. The recognition of redundant nerve roots at magnetic resonance imaging is important, particularly to avoid misdiagnosing other conditions such as intradural arteriovenous malformations. The literature approaching the clinical relevance of the presence of redundant nerve roots is controversial. There are articles suggesting that the pathological changes of the nerve roots are irreversible at the moment of diagnosis and therefore neurological symptoms are less likely to improve with surgical decompression, but such concept is not a consensus.

Fatores prognósticos associados ao tratamento cirúrgico da mielorradiculopatia espondilótica cervical

OBJETIVO: Identificar os fatores clínicos dos indivíduos, fatores sociais, ambientais e dos exames de imagem que se correlacionam ao resultado final de melhora neurológica em pacientes submetidos ao tratamento cirúrgico da mielopatia espondilótica cervical. MÉTODOS: A avaliação clínica foi quantificada pela escala deficitária da JOA. Analisamos 200 casos de mielorradiculopatia cervical, operados no HC-FMUSP, no período de janeiro de 1993 a janeiro de 2007. A média de segmento foi de 06 anos e 08 meses. A análise radiológica foi baseada nos critérios de instabilidade de White e scala de Kellgren. RESULTADOS: Em 80% houve melhora, 14% estabilização e em 6% piora do quadro neurológico. A piora neurológica não foi associada com nenhum fator clínico, ambiental ou de imagem. A melhora neurológica foi diretamente proporcional a menor idade na cirurgia, ausência de co-morbidade, sinal de Hoffman, atrofia muscular, hipersinal medular na RNM, menor período de evolução pré-operatório, melhor status neurológico pré-operatório e inversamente proporcional ao diâmetro AP do canal medular e multiplicidade de compressões. Identificou-se associação com o tabagismo. Mais de 70 anos, evolução superior a 24 meses, atrofia muscular, pontuação JOA igual ou inferior a sete pontos e diâmetro AP do canal inferior ou igual a seis mm não foram associado à melhora.

Metamorfismo ercinico di bassa-pressione: evoluzione tettonico-metamorfica del complesso di mandatoriccio (massiccio della Sila - Calabria)

Low-pressure/high-temperature (LP/HT) metamorphic belts are characterised by rocks that experienced abnormal heat flow in shallow crustal levels (T > 600 °C; P < 4 kbar) resulting in anomalous geothermal gradients (60-150 °C/km). The abnormal amount of heat has been related to crustal underplating of mantle-derived basic magmas or to thermal perturbation linked to intrusion of large volumes of granitoids in the intermediate crust. In particular, in this latter context, magmatic or aqueous fluids are able to transport relevant amounts of heat by advection, thus favouring regional LP/HT metamorphism. However, the thermal perturbation consequent to heat released by cooling magmas is responsible also for contact metamorphic effects. A first problem is that time and space relationships between regional LP/HT metamorphism and contact metamorphism are usually unclear. A second problem is related to the high temperature conditions reached at different crustal levels. These, in some cases, can completely erase the previous metamorphic history. Notwithstanding this problem is very marked in lower crustal levels, petrologic and geochronologic studies usually concentrate in these attractive portions of the crust. However, only in the intermediate/upper-crustal levels of a LP/HT metamorphic belt the tectono-metamorphic events preceding the temperature peak, usually not preserved in the lower crustal portions, can be readily unravelled. The Hercynian Orogen of Western Europe is a well-documented example of a continental collision zone with widespread LP/HT metamorphism, intense crustal anatexis and granite magmatism. Owing to the exposure of a nearly continuous cross-section of the Hercynian continental crust, the Sila massif (northern Calabria) represents a favourable area to understand large-scale relationships between granitoids and LP/HT metamorphic rocks, and to discriminate regional LP/HT metamorphic events from contact metamorphic effects. Granulite-facies rocks of the lower crust and greenschist- to amphibolite-facies rocks of the intermediate-upper crust are separated by granitoids emplaced into the intermediate level during the late stages of the Hercynian orogeny. Up to now, advanced petrologic studies have been focused mostly in understanding P-T evolution of deeper crustal levels and magmatic bodies, whereas the metamorphic history of the shallower crustal levels is poorly constrained. The Hercynian upper crust exposed in Sila has been subdivided in two different metamorphic complexes by previous authors: the low- to very low-grade Bocchigliero complex and the greenschist- to amphibolite-facies Mandatoriccio complex. The latter contains favourable mineral assemblages in order to unravel the tectono-metamorphic evolution of the Hercynian upper crust. The Mandatoriccio complex consists mainly of metapelites, meta-arenites, acid metavolcanites and metabasites with rare intercalations of marbles and orthogneisses. Siliciclastic metasediments show a static porphyroblastic growth mainly of biotite, garnet, andalusite, staurolite and muscovite, whereas cordierite and fibrolite are less common. U-Pb ages and internal features of zircons suggest that the protoliths of the Mandatoriccio complex formed in a sedimentary basin filled by Cambrian to Silurian magmatic products as well as by siliciclastic sediments derived from older igneous and metamorphic rocks. In some localities, metamorphic rocks are injected by numerous aplite/pegmatite veins. Small granite bodies are also present and are always associated to spotted schists with large porphyroblasts. They occur along a NW-SE trending transcurrent cataclastic fault zone, which represents the tectonic contact between the Bocchigliero and the Mandatoriccio complexes. This cataclastic fault zone shows evidence of activity at least from middle-Miocene to Recent, indicating that brittle deformation post-dated the Hercynian orogeny. P-T pseudosections show that micaschists and paragneisses of the Mandatoriccio complex followed a clockwise P-T path characterised by four main prograde phases: thickening, peak-pressure condition, decompression and peak-temperature condition. During the thickening phase, garnet blastesis started up with spessartine-rich syntectonic core developed within micaschists and paragneisses. Coevally (340 ± 9.6 Ma), mafic sills and dykes injected the upper crustal volcaniclastic sedimentary sequence of the Mandatoriccio complex. After reaching the peak-pressure condition (≈4 kbar), the upper crust experienced a period of deformation quiescence marked by the static overgrowths of S2 by Almandine-rich-garnet rims and by porphyroblasts of biotite and staurolite. Probably, this metamorphic phase is related to isotherms relaxation after the thickening episode recorder by the Rb/Sr isotopic system (326 ± 6 Ma isochron age). The post-collisional period was mainly characterised by decompression with increasing temperature. This stage is documented by the andalusite+biotite coronas overgrown on staurolite porphyroblasts and represents a critical point of the metamorphic history, since metamorphic rocks begin to record a significant thermal perturbation. Peak-temperature conditions (≈620 °C) were reached at the end of this stage. They are well constrained by some reaction textures and mineral assemblages observed almost exclusively within paragneisses. The later appearance of fibrolitic sillimanite documents a small excursion of the P-T path across the And-Sil boundary due to the heating. Stephanian U-Pb ages of monazite crystals from the paragneiss, can be related to this heating phase. Similar monazite U-Pb ages from the micaschist combined with the lack of fibrolitic sillimanite suggest that, during the same thermal perturbation, micaschists recorded temperatures slightly lower than those reached by paragneisses. The metamorphic history ended with the crystallisation of cordierite mainly at the expense of andalusite. Consequently, the Ms+Bt+St+And+Sill+Crd mineral assemblage observed in the paragneisses is the result of a polyphasic evolution and is characterised by the metastable persistence of the staurolite in the stability fields of the cordierite. Geologic, geochronologic and petrographic data suggest that the thermal peak recorded by the intermediate/upper crust could be strictly connected with the emplacement of large amounts of granitoid magmas in the middle crust. Probably, the lithospheric extension in the relatively heated crust favoured ascent and emplacement of granitoids and further exhumation of metamorphic rocks. After a comparison among the tectono-metamorphic evolutions of the different Hercynian crustal levels exposed in Sila, it is concluded that the intermediate/upper crustal level offers the possibility to reconstruct a more detailed tectono-metamorphic history. The P-T paths proposed for the lower crustal levels probably underestimate the amount of the decompression. Apart from these considerations, the comparative analysis indicates that P-T paths at various crustal levels in the Sila cross section are well compatible with a unique geologic scenario, characterized by post-collisional extensional tectonics and magmas ascent.

Comparison of model potentials for molecular dynamics simulation of crystalline silica

Simulationen von SiO2 mit dem von van Beest, Kramer und vanSanten (BKS) entwickelten Paarpotenzial erzeugen vielezufriedenstellende Ergebnisse, aber auch charakteristischeSchwachstellen. In dieser Arbeit wird das BKS-Potenzial mitzwei kürzlich vorgeschlagenen Potenzialen verglichen, dieeffektiv Mehrteilchen-Wechselwirkungen beinhalten. Der ersteAnsatz erlaubt dazu fluktuierende Ladungen, der zweiteinduzierbare Polarisierungen auf den Sauerstoffatomen. Die untersuchten Schwachstellen des BKS Potenzialsbeinhalten das Verhältnis der zwei Gitterkonstanten a und cim Quarzübergang, das von BKS falsch beschrieben wird.Cristobalit und Tridymit erscheinen instabil mit BKS.Weiterhin zeigt die BKS-Zustandsdichte charakteristischeAbweichungen von der wahren Zustandsdichte. DerÜbergangsdruck für den Stishovit I-II Übergang wird deutlichüberschätzt. Das Fluktuierende-Ladungs-Modell verbesserteinige der genannten Punkte, reproduziert aber viele andereEigenschaften schlechter als BKS. DasFluktierende-Dipol-Modell dagegen behebt alle genanntenArtefakte. Zusätzlich wird der druckinduzierte Phasenübergang imalpha-Quarz untersucht. Alle Potentiale finden die selbeStruktur für Quarz II. Bei anschliessender Dekompressionerzeugt BKS eine weitere Phase, während die beiden anderenPotentiale wieder zum alpha-Quarz zurückkehren. Weiterhinwerden zwei Methoden entwickelt, um die piezoelektrischenKonstanten bei konstantem Druck zu bestimmen. Die Ergebnissegeben Hinweise auf eine möglicherweisenicht-elektrostatische Natur der Polarisierungen imFluktuierende-Dipole-Modell. Mit dieser Interpretation scheint das Fluktuierende-DipolPotential alle verfügbaren experimentellen Daten am bestenvon allen drei untersuchten Ansätzen zu reproduzieren.

Geochronology, geochemistry and isotopic compositions of the volcanic rocks from oceanic (Hawaii) and continental (Eifel) intra-plate environments

The Eifel volcanism is part of the Central European Volcanic Province (CEVP) and is located in the Rhenish Massif, close to the Rhine and Leine Grabens. The Quaternary Eifel volcanism appears to be related to a mantle plume activity. However, the causes of the Tertiary Hocheifel volcanism remain debated. We present geochronological, geochemical and isotope data to assess the geotectonic settings of the Tertiary Eifel volcanism. Based on 40Ar/39Ar dating, we were able to identify two periods in the Hocheifel activity: from 43.6 to 39.0 Ma and from 37.5 to 35.0 Ma. We also show that the pre-rifting volcanism in the northernmost Upper Rhine Graben (59 to 47 Ma) closely precede the Hocheifel volcanic activity. In addition, the volcanism propagates from south to north within the older phase of the Hocheifel activity. At the time of Hocheifel volcanism, the tectonic activity in the Hocheifel was controlled by stress field conditions identical to those of the Upper Rhine Graben. Therefore, magma generation in the Hocheifel appears to be caused by decompression due to Middle to Late Eocene extension. Our geochemical data indicate that the Hocheifel magmas were produced by partial melting of a garnet peridotite at 75-90 km depth. We also show that crustal contamination is minor although the magmas erupted through a relatively thick continental lithosphere. Sr, Nd and Pb isotopic compositions suggest that the source of the Hocheifel magmas is a mixing between depleted FOZO or HIMU-like material and enriched EM2-like material. The Tertiary Hocheifel and the Quaternary Eifel lavas appear to have a common enriched end-member. However, the other sources are likely to be distinct. In addition, the Hocheifel lavas share a depleted component with the other Tertiary CEVP lavas. Although the Tertiary Hocheifel and the Quaternary Eifel lavas appear to originate from different sources, the potential involvement of a FOZO-like component would indicate the contribution of deep mantle material. Thus, on the basis of the geochemical and isotope data, we cannot rule out the involvement of plume-type material in the Hocheifel magmas. The Ko’olau Scientific Drilling Project (KSDP) has been initiated in order to evaluate the long-term evolution of Ko’olau volcano and obtain information about the Hawaiian mantle plume. High precision Pb triple spike data, as well as Sr and Nd isotope data on KSDP lavas and Honolulu Volcanics (HVS) reveal compositional source variations during Ko’olau growth. Pb isotopic compositions indicate that, at least, three Pb end-members are present in Ko’olau lavas. Changes in the contributions of each component are recorded in the Pb, Sr and Nd isotopes stratigraphy. The radiogenic component is present, at variable proportion, in all three stages of Ko’olau growth. It shows affinities with the least radiogenic “Kea-lo8” lavas present in Mauna Kea. The first unradiogenic component was present in the main-shield stage of Ko’olau growth but its contribution decreased with time. It has EM1 type characteristics and corresponds to the “Ko’olau” component of Hawaiian mantle plume. The second unradiogenic end-member, so far only sampled by Honololu lavas, has isotopic characteristics similar to those of a depleted mantle. However, they are different from those of the recent Pacific lithosphere (EPR MORB) indicating that the HVS are not derived from MORB-related source. We suggest, instead, that the HVS result from melting of a plume material. Thus the evolution of a single Hawaiian volcano records the geochemical and isotopic changes within the Hawaiian plume.

Untersuchung zum Einfluss der ACD-CPR mit während der Dekompressionsphase blockiertem Gasfluss (ITD) im Vergleich zur Standard-Reanimationstechnik auf die Kurzzeit-Überlebensrate von Patienten mit präklinisch aufgetretenem Herzkreislaufstillstand

Untersuchung zum Einfluss der ACD-CPR (Aktive Kompressions- Dekompressions-Reanimation) mit während der Dekompressionsphase blockiertem Gasfluss (Impedance-Threshold-Device) im Vergleich zur Standardreanimationsrechnik auf die Kurzzeit-Überlebensrate von Patienten mit präklinisch aufgetretenem Herzkreislaufstillstand. Die Studie vergleicht die ACD-ITD-CPR gegen die Standard-CPR bei Patienten mit präklinischem Herkreislaufstillstand. Primär untersuchter Parameter war die Ein-Stunden-Überlebensrate nach Krankenhausaufnahme. Sekundär wurden die Tastbarkeit eines Pulses unter CPR, die Wiederkehr des Spontankreislaufs (ROSC), die Rate an Krankenhausaufnahmen, 24-Stunden-Überleben und Krankenhausentlassungen untersucht. Außerdem wurde das neurologische Outcome evaluiert. Die Studie fand in Mainz statt; Mainz bietet sich für die Durchführung notfallmedizinischer Studien in besonderem Maße an. Der Rettungsdienst der Stadt arbeitet nach dem in Deutschland üblichen zweigliedrigen System mit RA/RS auf RTWs und NA auf NAW/NEF. Die Studie wurde nach einer fünfmonatigen Pilotphase und extensivem Training beider Verfahren durchgeführt. Zusätzlich bestanden bei einigen der Beteiligten schon Erfahrungen mit ACD-CPR. Es ergaben sich signifikante Vorteile der ACD-ITD-CPR gegenüber der Standard-CPR hinsichtlich des primär untersuchten Parameters (51% vs. 32% p=0,006), außerdem statistisch auffällige Vorteile hinsichtlich der Pulstastbarkeit unter CPR (85% vs. 69%, p=0,008), der Wiederkehr des Spontankreislaufs (55% vs. 37%, p=0,016), der Rate der Krankenhausaufnahmen (52% vs. 36%, p=0.023) und des 24-Stunden-Überlebens (37% vs. 22%, p=0,033). Es ergaben sich keine statistisch auffälligen Unterschiede hinsichtlich der Rate an Krankenhausentlassungen und im neurologischen Outcome. Die Ergebnisse lassen den Schluss zu, dass die ACD-ITD die Kurzzeitüberlebensrate der Patienten mit außerklinischem Herzkreislaufstillstand verbessern kann. Eine Voraussetzung hierfür ist eine ausreichende und andauernde Ausbildung der beteiligten Helfer und/oder die Verfügbarkeit technisch verbesserter Lösungen. Weitere Untersuchungen zum Einfluss auf die Langzeitüberlebensraten und das neurologische Outcome scheinen angezeigt.

Auswirkungen einer hypertonen, hyperonkotischen Therapie in Kombination mit chirurgischer Hämatomentfernung auf funktionelle und histologische Defizite nach akutem subduralem Hämatom der Ratte

Auswirkungen einer hypertonen / hyperonkotischen Therapie in Kombination mit chirurgischer Hämatomentfernung auf funktionelle und histologische Defizite nach akutem subduralem Hämatom der Ratte: Die Zeit bis zur Behandlung eines akuten subduralen Hämatoms stellt eine der wichtigsten prognosebestimmenden Faktoren für die Mortalität und Morbidität der Patienten dar. Ein unbehandeltes akutes subdurales Hämatom im Rahmen eines schweren Schädelhirntraumas geht mit einer Sterblichkeit von weit über 50% einher. Selbst bei zeitiger chirurgischer Entlastung versterben noch ca. 30% der Patienten als Folge der Hirnschädigung. Um Therapieoptionen zur Verbesserung der schlechten Prognose nach akutem subduralem Hämatom liefern zu können, wurde in dieser Studie die frühe Therapie mit hypertonen / hyperonkotischen Lösungen (HHT) sowie die Kombination mit chirurgischer Evakuation des Hämatoms untersucht. In dem genutzten Tiermodell wurde ein subdurales Hämatom über die Infusion von 400 µl autologen venösen Blutes erreicht. Je nach Gruppe erhielten die Ratten 30 Minuten nach ASDH eine HHT oder isotonische Kochsalzlösung und ggf. eine chirurgische Entfernung des Hämatoms eine Stunde nach Induktion. Die Studie war in zwei Teile getrennt. Die akute Studie welche den intraoperativen Verlauf von Blutwerten, intrakraniellem Druck zerebralem Perfusionsdruck und zerebralem Blutfluss untersuchte und die chronische Studie welche über Verhaltenstests (Neuroscore, Beamwalk, Open Field) die funktionellen und histologischen Ergebnisse im Verlauf von 12 Tage betrachtete. Im Ergebnis konnten durch eine HHT eine Reduktion der intrakraniellen Hypertension erreicht werden. Im Langzeit Verlauf schnitten alle Behandlungen besser ab als die unbehandelte Gruppe. In Bezug auf die neurologische Erholung und das histologische Defizit zeigten die mit einer HHT behandelten Tiere jedoch die besten Ergebnisse. rnEine frühe chirurgische Intervention ist eine protektive Maßnahme bezogen auf die funktionelle Defizite und den histologischen Schaden nach akutem subduralem Hämatom, aber frühe hypertone / hyperonkotische Behandlung ist in diesem Modell sogar noch effektiver. Eine frühe Behandlung mit hypertonen / hyperonkotischen Lösungen stellt somit eine vielversprechende, sichere und kausale Therapieoption zur Verbesserung der Prognose nach akutem subduralem Hämatom dar. rn