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Christos Lazaridis, Stacia M. DeSantis, Peter Smielewski, David K. Menon, Peter Hutchinson, John D. Pickard, and Marek Czosnyka

I ntracranial hypertension has been closely linked to adverse outcomes after traumatic brain injury (TBI); nevertheless there have been no large randomized trials that directly compare intracranial pressure (ICP) treatment thresholds. Data from observational studies and noncontrolled series have suggested thresholds ranging from 15 to 25 mm Hg. 2 , 11 , 20 , 25 , 28 The Brain Trauma Foundation's (BTF's) latest guideline 5 has identified a lack of Level I evidence and offered, as a Level II, the treatment threshold of 20 mm Hg, mainly based on the largest

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Magdalena Hiler, Marek Czosnyka, Peter Hutchinson, Marcella Balestreri, Peter Smielewski, Basil Matta, and John D. Pickard

, Parks SN : Routinely repeated computed tomography after blunt head trauma: does it benefit patients? . J Trauma 56 : 475 – 481 , 2004 12 Lang EW , Chestnut RM : A bedside method for investigating the integrity and critical thresholds of cerebral pressure autoregulation in severe traumatic brain injury patients . Br J Neurosurg 14 : 117 – 126 , 2000 13 Lee TT , Aldana PR , Kirton OC , Green BA : Follow-up computerized tomography (CT) scans in moderate and severe head injuries: correlation with Glasgow Coma Scores (GCS), and complication

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Eric A. Schmidt, Marek Czosnyka, Luzius A. Steiner, Marcella Balestreri, Piotr Smielewski, Stefan K. Piechnik, Basil F. Matta, and John D. Pickard

: Blood pressure and intracranial pressure-volume dynamics in severe head injury: relationship with cerebral blood flow. J Neurosurg 77 : 15 – 19 , 1992 Bouma GJ, Muizelaar JP, Bandoh K, et al: Blood pressure and intracranial pressure-volume dynamics in severe head injury: relationship with cerebral blood flow. J Neurosurg 77: 15–19, 1992 4. Bullock RM , Chesnut RM , Clifton GL , et al : Part 1: Guidelines for the management of severe traumatic brain injury. J Neurotrauma 17 : 451 – 553 , 2000 Bullock

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Marek Czosnyka, Piotr Smielewski, Stefan Piechnik, Luzius A. Steiner, and John D. Pickard

, et al : Evidence of cerebral ischemia following traumatic brain injury. Restor Neurol Neurosci 16 : 215 , 2000 (Abstract) Coles JP, Fryer TD, Williams EJ, et al: Evidence of cerebral ischemia following traumatic brain injury. Restor Neurol Neurosci 16: 215, 2000 (Abstract) 9. Cruz J : The first decade of continuous monitoring of jugular bulb oxyhemoglobinsaturation: management strategies and clinical outcome. Crit Care Med 26 : 344 – 351 , 1998 Cruz J: The first decade of continuous monitoring of

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Marek Czosnyka, Marcella Balestreri, Luzius Steiner, Piotr Smielewski, Peter J. Hutchinson, Basil Matta, and John D. Pickard

indicate that worsening of the indices of blood-flow regulation with age is responsible for the worse outcomes. Indeed, in all our previous studies, when these indices were considered they were strong and independent predictors of outcome after traumatic brain injury. 7, 8, 25 This finding obviously does not exclude other possible factors; 2 in fact, it does not even indicate that failure of autoregulation is a direct cause of worse outcome in elderly patients. In some age-related cerebral degenerative disorders, such as Alzheimer disease, vascular function has been

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Rupert Kett-White, Peter J. Hutchinson, Pippa G. Al-Rawi, Marek Czosnyka, Arun K. Gupta, John D. Pickard, and Peter J. Kirkpatrick

–757, 1996 15. Lang EW , Mehdorn HM : The effect of controlled CPP variations on brain tissue pO 2 and cerebral blood flow velocity after severe traumatic brain injury. Zentralbl Neurochir 60 : 35 , 1999 (Abstract) Lang EW, Mehdorn HM: The effect of controlled CPP variations on brain tissue pO 2 and cerebral blood flow velocity after severe traumatic brain injury. Zentralbl Neurochir 60: 35, 1999 (Abstract) 16. Lavine SD , Masri LS , Levy ML , et al : Temporary occlusion of the middle

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Marek Czosnyka, Piotr Smielewski, Stefan Piechnik, Eric A. Schmidt, Pippa G. Al-Rawi, Peter J. Kirkpatrick, and John D. Pickard

, Becker DP : Origin and evolution of plateau waves. Experimental observations and a theoretical model. J Neurosurg 60 : 312 – 324 , 1984 Rosner MJ, Becker DP: Origin and evolution of plateau waves. Experimental observations and a theoretical model. J Neurosurg 60: 312–324, 1984 35. Signorini DF , Andrews PJD , Jones PA , et al : Adding insult to injury: the prognostic value of early secondary insults for survival after traumatic brain injury. J Neurosurg Neurol Psychiatry 66 : 26 – 31 , 1999 Signorini DF, Andrews PJD, Jones PA, et al: Adding

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Nicole C. H. Keong, Alonso Pena, Stephen J. Price, Marek Czosnyka, Zofia Czosnyka, and John D. Pickard

valuable in translating this tool to NPH. Interpretation of DTI measures across a range of pathological conditions, such as demyelination, acute traumatic brain injury, dementia, and ischemia, may be applicable to the white matter injury patterns in NPH, particularly due to the fact that the underlying pathological mechanisms in this condition have not been fully elucidated (see Table 3 for a summary of key concepts and conundrums). To this end, the concept of imaging reversible white matter injury may lead to the next leap in the understanding of the enigma known as

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Georgios V. Varsos, Angelos G. Kolias, Peter Smielewski, Ken M. Brady, Vassilis G. Varsos, Peter J. Hutchinson, John D. Pickard, and Marek Czosnyka

Neurocritical Care Unit of Addenbrooke's Hospital between 2002 and 2011. 10 The demographics of the patients are summarized in Table 1 . All patients suffered a traumatic brain injury (TBI) and had an abnormal CT scan of the head. Patients were sedated, ventilated, and managed in the Neurocritical Care Unit with a tiered therapeutic protocol aiming for an ICP < 25 mm Hg and CPP around 60–70 mm Hg. The median preintubation Glasgow Coma Scale (GCS) score of the patients was 6 (range 3–15), while the Glasgow Outcome Scale (GOS) score, assessed 6 months after injury, varied

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Afroditi Despina Lalou, Marek Czosnyka, Joseph Donnelly, John D. Pickard, FMedSci, Eva Nabbanja, Nicole C. Keong, Matthew Garnett, and Zofia H. Czosnyka

There is still no alternative clinical test and consensus to aid the clinical decision of whether there is concomitant disturbance of the CSF circulation and cerebrovascular disease, or whether the CSF circulation is normal and the problem lies purely in the vasculature. 10 , 22 , 24 The PRx showed no correlation with age, which is surprising, because such a significant correlation (i.e., between PRx and age) may be seen in patients receiving anesthesia and ventilation after traumatic brain injury. 9 , 20 An additional similar correlation was shown between age and