NNS 2015 Program & Abstract Book

D5-06

RELATIONSHIP OF SIMULTANEOUSLY RECORDED VEN-

TRICULAR AND PARENCHYMAL INTRACRANIAL PRES-

SURE

Mark Krasberg

, Omar Akbik, Peter Shin, Edwin Nemoto, Howard

Yonas

University of New Mexico, Neurosurgery, Albuquerque, USA

Evidence has shown that decreased cerebral perfusion pressures are

correlated with poor outcomes in traumatic brain injury. Reliable CPP

measurements depend on continuous mean arterial pressure and intra-

cranial pressure measurements. Current Brain Trauma guidelines rec-

ommend intracranial pressure monitoring in all traumatic brain injured

patients with a GCS of 3–8 with an abnormal CT scan. Furthermore,

treating elevated intracranial pressures without monitoring has potential

risks and has shown to be deleterious. While both parenchymal and

ventricular monitors are widely used, each has its own advantages and

drawbacks with selection depending on a host of factors. Our institution,

University of New Mexico Hospital, recently published its 5 year ex-

perience with the Hummingbird Monitoring system (InnerSpace Medi-

cal), a multi-modality monitoring system that provides a multi-port

device allowing for both parenchymal and ventricular ICP monitors as

well as for tissue oxygenation and cerebral blood flow measurements

from within the adjacent deep white matter. All data is acquired via the

Component Neuromonitoring System (CNS, Moberg Technologies).

The availability of both types of ICP readings has allowed for optimal

management of a TBI patient in which CSF can be drained from the

ventricular drain while still measuring the intracranial pressure from the

parenchymal monitor. The continuous stream of dual ICP measurements

makes it possible not only to determine the precise relationship between

parenchymal ICP and ventricular ICP but also to determine quantitative

values regarding the effects of CSF drainage on ICP. From analyzing

30 TBI patients we show that the intraparenchymal pressures are, on

average, slightly lower than the ventricular pressures. We also demon-

strate that CSF drainage, resulting in a decrease in ICP, can correlate with

an increase in tissue oxygenation. In recent literature, the validity of

intracranial monitors in TBI patients has come under question. With the

above findings, we believe that there is a spectrum of TBI physiology

between which a multi-modality system can help differentiate.

Keywords: Multimodal, EVD, parenchymal, ventricular, drain, ICP

D5-07

SYMPTOMOLOGY OBSERVED IN HUMANS FOLLOWING

ACUTE EXPOSURE TO EXPLOSIVE BLAST

Walter Carr

, Maura Taylor

, Matthew LoPresti

, Luke Aurich

Timothy Walilko

, Angela Yarnell

, Gary Kamimori

, Uade da Silva

Elena Polejaeva

, Richard McCarron

WRAIR, Behavioral Biology, Silver Spring, USA

ARA, Rocky Mountain Division, Littleton, USA

NMRC, Neurotrauma, Silver Spring, USA

Exposure to explosive blast clearly presents risk for neurotrauma but

blast magnitude, number, or frequency that represents threshold for

injury remains unknown. Among studies involving human subjects,

there is a series of studies on personnel exposed to repeated blast as a

condition of their occupation. These professionals do not accrue

clinical diagnosis from occupational blasts, but a previous study

showed that they report symptomology consistent with concussion

and that correlates with degree of blast exposure. To examine with

prospective data, the present study assessed acute symptom endorse-

ment at timepoints across a series of exposures to blast. Thirty-two

military personnel completed a daily assessment battery during a 10-

day training protocol that included use of explosives in close prox-

imity. A key outcome measure was a 32-item symptom checklist with

5-level Likert scale responses. Outcome measures also included

postural stability, cognitive performance, sleep, and a blood-based

neurotrauma biomarker. Blast was recorded with pressure gauges

worn by each individual. Symptoms following acute exposure to blast

were similar to those previously reported with chronic exposure. The

prospective design revealed that not all blast exposures were associ-

ated with change in symptom reporting. Symptoms were elevated

following only the largest blast, with recorded peak overpressure

ranging from 5 to 12 psi across individuals. Daily symptom reporting

mapped more closely to blast magnitude than did other outcome

measures. Effects of blast in standard training protocols are expected

to be small, if present at all, given that this type of blast exposure is

not known to result in diagnosed injury, medical aid, or removal from

training. Effects may have similarity to subconcussive hits in contact

sports. Until a reliable biomarker for mild neurotrauma becomes

available, self-report symptomology may be the best indicator for

effects on the brain from low level blast.

Keywords: blast, symptomology, military, subconcussive

D6 Poster Session VII - Group D: Rehabilitation

D6-01

SPONTANEOUS FRACTURE OF CRANIOPLASTIC TITA-

NIUM IMPLANTS WITHOUT HEAD TRAUMA IN AN

ADULT: A CASE STUDY

Mingkun Yu

Shanghai Changzheng Hospital, Neurosurgery, Shanghai, China

The cranioplasty is a classical surgical procedure carried out to repair

large skull defects. The most current cranioplasty using computer-

based design and modeling implants provides the best results to meet

both cosmetic and functional requirement of patients. So far, the ti-

tanium is the only metal implants used, which features multiple ad-

vantages, including strong strength and malleability. In the current

report, we documented the first case of cranioplastic titanium mesh

implant fracture at the frontal-parietal-temporal locus, which occurred

13 months postoperatively without any trauma or extra force on the

head. Additionally, the implant was detached from the basitemporal

locus. A second cranioplasty was performed and the follow-up result

was unremarkable at 8 month post-second-operation. This case is the

first reported incidence of spontaneous fracture of titanium mesh

implant without extra force on head in an adult.

Keywords: fracture; cranioplastic; titanium; implants

D6-02

EXAMINATION OF STEPPING AND TAIL OSCILLATIONS

AS A RESULT OF TEMPORAL RELATIONS AND FRE-

QUENCY

Misty Strain

, Melissa Brumley, Derek Lehtonen, Brandon Pesek,

Lauren Murphy, Joel Turtle, James Grau

Texas A&M University, TAMIN, College Station, USA

Our laboratory has shown that the spinal cord is sensitive to temporal

relations. Specifically, stimuli presented in a regular (fixed, FT) or

A-109