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Surgical decompression for cerebral oedema in acute ischaemic stroke

About four‐fifths of strokes are due to blockage of an artery in the brain. When the artery is blocked, part of the brain is damaged, this is called a cerebral infarct. If a large artery is blocked the area of brain damage can be large. About 24 to 48 hours after a large infarct the brain can swell, causing a dangerous rise of pressure inside the head. Surgery to remove some of the skull bone over the swollen area of brain reduces the pressure. Results from recent clinical trials showed that surgery reduced the risk of death. However, survivors were left with moderate to severe disability requiring help in their daily life activities. These results only apply to people 60 years of age or younger.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Bradykinin beta‐2 receptor antagonists for traumatic brain injury

Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Not all damage to the brain occurs at the moment of injury. The injury sustained at the moment of impact (primary brain injury) initiates a sequence of mechanisms which cause further brain damage (secondary brain injury).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Fluid restriction for term infants with hypoxic‐ischaemic encephalopathy following perinatal asphyxia

Plain language summary will be included with future review update.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Corticosteroids for acute ischaemic stroke

There is no evidence of benefit from corticosteroids for acute ischaemic stroke. Stroke from blockage of an artery to a part of the brain causes swelling of that part of the brain. The swelling produces pressure effects, may cause additional brain cells to die, or delays the recovery of damaged but recoverable brain cells. Reduction of this swelling may relieve pressure on adjacent parts of the brain, reduce the number of brain cells that are killed and allow better recovery of damaged brain cells. Corticosteroids have been used to reduce this brain swelling in order to help limit damage and speed recovery. However, from the small and inadequate amount of evidence available from eight trials involving 466 participants, this review found no benefit of corticosteroids on reducing the number of deaths or improving functional outcome in survivors.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Mannitol for acute stroke

Brain swelling (oedema) is a major cause of early death and long‐term disability after stroke (a sudden catastrophe in the brain either because an artery to the brain blocks, or because an artery in or on the brain ruptures and bleeds). Mannitol solution is given into a vein to reduce the swelling. Increased (rebound) swelling in the brain can occur after the treatment is stopped. This review of three small trials, involving 226 participants, found that there was not enough evidence to decide if mannitol improves survival or prevents disability after stroke. The treatment can cause a number of adverse effects, but no serious adverse events were reported in the trials included in this review. More research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Glycerol for acute stroke

There is not enough evidence to show if glycerol can reduce the disabling effects of brain swelling due to acute stroke. Brain swelling (or oedema) is a major cause of early death and long‐term disability after stroke (a sudden catastrophe in the brain either because an artery to the brain blocks, or because an artery in or on the brain ruptures and bleeds). A 10% solution of glycerol might reduce brain swelling and therefore reduce the risk of death and long‐term disability after a stroke. The review found some evidence that glycerol improves the short term survival after stroke, but there was not enough evidence to decide whether glycerol helps avoid disability after stroke. Adverse effects of glycerol treatment did not happen often, but a small number of treated patients were found to have blood in their urine (this disappeared after the glycerol treatment was stopped). More research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Saponins from Chinese buckeye seed reduce cerebral edema: metaanalysis of randomized controlled trials

This review assessed the effectiveness and safety of saponins from Chinese buckeye seed in the treatment of cerebral oedema in patients with stroke or cerebral trauma. The authors concluded that while saponins can reduce cerebral oedema, the poor quality of the available studies does not allow firm conclusions to be drawn. This conclusion appears reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Hemicraniectomy for massive middle cerebral artery territory infarction: a systematic review

BACKGROUND AND PURPOSE: Hemicraniectomy and durotomy have been proposed in many small series to relieve intracranial hypertension and tissue shifts in patients with large hemispheric infarcts, thereby preventing death from herniation. Our objective was to review the literature to identify patients most likely to benefit from hemicraniectomy.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

Magnesium for acute traumatic brain injury

Traumatic head injury is a leading cause of death and disability in the teenage population, primarily arising from traffic accidents. The estimated annual cost of treating and rehabilitating victims of head injury is approximately US$2Billion in the United States alone. Most of the neurological damage occurs at the time of injury, though the hours or days following the injury account for addition damage. It is believed that excessive calcium entry into the cells is the biggest threat to brain damage, in which the calcium excess ultimately leads to increased free radicals, proteolysis, initiation of apoptosis, and inflammation. As one of the most important ions in the central nervous system, magnesium is important in various physiological effects, such as ischemia, cellular energy metabolism, and protein synthesis. Magnesium is also a potent calcium channel blocker, and helps to control intracellular calcium activity. Magnesium increases cardiac output and cerebral blood flow. Low levels of magnesium can lead to an increase of intracellular calcium levels. Hypomagnesaemia is a risk to head injuries, and this has been associated with poor neurological outcome and increased mortality. Restoring the levels of magnesium may reduce edema, improve neurological and cognitive outcomes, and help with problems associated with ischemia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

No evidence that cooling patients undergoing brain surgery helps to either reduce death and severe disability or increase harm

Brain surgery is often required in patients who have abnormal brain blood vessels, had a stroke, sustained a traumatic injury or have suffered spontaneous bleeding into the brain. While surgery can be lifesaving it can also cause further damage due to an associated interruption and reduction of blood flow to the brain cells. Without an adequate supply of blood the brain cells are deprived of oxygen and they may die as a result. If brain cells are lost in large numbers or in important areas of the brain, the patient may die or be severely disabled. This has led to a search for ways to protect the brain cells during brain operations. Studies in animals have shown that lowering the body temperature can help to protect the brain cells in circumstances when the blood supply to the cells is compromised. Similarly, studies in humans who have been resuscitated after their heart stopped beating have shown that lowering their body temperature helps to reduce brain damage. The purpose of this updated version of a previous review of the same title was to determine whether cooling patients who were having brain surgery reduced death and serious disability, or was associated with increased risk of harm. A detailed search of the available literature up until May 2014 identified four eligible studies that included a total of 1219 participants. Their results were combined to answer these questions. No evidence was found that cooling patients who are having brain operations reduced the risk of death or severe disability, or produced significant harm.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Mannitol and other osmotic diuretics as adjuncts for treating cerebral malaria

Cerebral malaria can lead to coma and death, even when the patient is given anti‐malarial drugs. Death is caused by the malaria parasites in the brain that cause brain swelling, leading to pressure in the brain. Mannitol is a drug that sometimes reduces brain swelling in other situations, such as traumatic head injury.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

High-osmolarity saline in neurocritical care: systematic review and meta-analysis

BACKGROUND AND PURPOSE: Intracranial hypertension and cerebral edema are known contributors to secondary brain injury and to poor neurologic outcomes. Small volume solutions of exceedingly high osmolarity, such as 23.4% saline, have been used for the management of intracranial hypertension crises and as a measure to prevent or reverse acute brain tissue shifts. We conducted a systematic literature review on the use of 23.4% saline in neurocritically ill patients and a meta-analysis of the effect of 23.4% saline on intracranial pressure reduction.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Complications of Mild Traumatic Brain Injury in Veterans and Military Personnel: A Systematic Review [Internet]

Traumatic brain injury (TBI) is a common condition, especially among military members. Twelve to 23 percent of service members returning from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND) experienced a TBI while deployed. Although various criteria are used to define TBI severity, the majority of documented TBI events among OEF/OIF/OND service members may be classified as mild in severity, or mTBI, according to the definition used by the Veterans Health Administration and Department of Defense (VA/DoD).

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: January 2013
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Optimal Oxygen Saturation Range for Adults Suffering from Traumatic Brain Injury: A Review of Patient Benefit, Harms, and Guidelines [Internet]

The purpose of this review is to examine the clinical outcomes and safety of different oxygen saturation levels in adults with traumatic brain injury (TBI). The guidelines associated with oxygen saturation for adults with TBI will also be examined.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: April 11, 2014
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Acetazolamide for the prevention of acute mountain sickness: a systematic review and meta-analysis

BACKGROUND: Acetazolamide has been reported to be effective in the prevention of acute mountain sickness (AMS). Our aim was to conduct a systematic review of randomized, placebo-controlled trials of acetazolamide in the prevention of AMS.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Systematic Review of Head Cooling in Adults After Traumatic Brain Injury and Stroke

Brain injuries resulting from trauma and stroke are common and costly. Cooling therapy may reduce damage and potentially improve outcome. Head cooling targets the site of injury and may have fewer side effects than systemic cooling, but there has been no systematic review and the evidence base is unclear.

Health Technology Assessment - NIHR Journals Library.

Version: November 2012
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Suspected Cancer: Recognition and Referral

Cancer is an important condition, both in terms of the number of people affected and the impacts on those people and the people close to them. Around one third of a million new cancers are diagnosed annually in the UK, across over 200 different cancer types. Each of these cancer types has different presenting features, though there may be overlap. More than one third of the population will develop a cancer in their lifetime. Although there have been large advances in treatment and survival, with a half of cancer sufferers now living at least ten years after diagnosis, it remains the case that more than a quarter of all people alive now will die of cancer.

NICE Guideline - National Collaborating Centre for Cancer (UK).

Version: June 2015
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Rifaximin (Zaxine): For the Reduction in Risk of Overt Hepatic Encephalopathy (HE) Recurrence in Patients ≥ 18 Years of Age [Internet]

The objective of this report was to perform a systematic review of the beneficial and harmful effects of rifaximin for reducing the risk of overt hepatic encephalopathy (HE) recurrence in patients ≥ 18 years of age who are at risk of HE recurrence despite the use of lactulose, or who are intolerant to lactulose.

Common Drug Review - Canadian Agency for Drugs and Technologies in Health.

Version: July 2015
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Drugs assessed by IQWiG: Overview

Since early 2011, the added benefit of most medications containing new active ingredients must be assessed as soon as they enter the market in Germany. The most important results of the IQWiG reviews are summarized here.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 1, 2017

Review article: prehospital fluid management in traumatic brain injury

The early management of patients who have sustained traumatic brain injury is aimed at preventing secondary brain injury through avoidance of cerebral hypoxia and hypoperfusion. Especially in hypotensive patients, it has been postulated that hypertonic crystalloids and colloids might support mean arterial pressure more effectively by expanding intravascular volume without causing problematic cerebral oedema. We conducted a systematic review to investigate if hypertonic saline or colloids result in better outcomes than isotonic crystalloid solutions, as well as to determine the safety of minimal volume resuscitation, or delayed versus immediate fluid resuscitation during prehospital care for patients with traumatic brain injury. We identified nine randomized controlled trials and one cohort study examined the effects of hypertonic solutions (with or without colloid added) for prehospital fluid resuscitation. None has reported better survival and functional outcomes over the use of isotonic crystalloids. The only trial of restrictive resuscitation strategies was underpowered to demonstrate its safety compared with aggressive early fluid resuscitation in head injured patients, and maintenance of cerebral perfusion remains the top priority.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

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