Secondary Brain Injury in Intracerebral Hemorrhage

描述(申请人提供)：急性原发非外伤性脑内 出血(ICH)是一种常见的疾病，目前还没有治疗方法 在改善死亡率和功能预后方面已被证明是有益的。事实上，在那里 关于非物质文化遗产创建初级和非传染性疾病的机制仍然存在争议 继发性脑损伤。这项提案的总体目标是产生一个 将教学、指导和临床研究相结合的计划 以亨菲尔医生在神经危重护理方面的培训为基础，从而 让他发展成为一名独立的临床研究人员 脑出血的损伤机制及治疗。 而在缺血性中风、头部创伤和蛛网膜下腔的管理决策 可根据临床和诊断监测进行出血 继发性脑损伤，这在脑出血中的作用尚不清楚。整体而言 这个项目的假设是继发性脑损伤会产生不利影响 脑出血后的预后及减少继发性脑损伤的方法 脑出血后的预后会有所改善。这将通过一系列的 与临床、神经监测和神经影像评估相关的研究 脑出血的继发性脑损伤，最终导致脑出血的先导性临床试验 治疗。研究将解决以下问题： 1)临床二次脑损伤的影响(全身缺氧， 低血压、发烧和癫痫)对结果的影响， 2)脑组织缺氧的影响(通过直接监测 神经科重症监护病房中的脑组织氧分压)对结果的影响， 3)动态CT显示脑组织缺氧与缺血的相关性 灌注和磁共振弥散加权成像，以及 4)在脑出血先导性研究中靶向继发性脑损伤的可行性 治疗。 这项研究应该会提供新的和重要的信息 脑出血后继发性脑损伤。与说教培训和 进行指导，该计划将促进亨菲尔博士发展成为 神经学危重护理领域的独立研究人员，特别关注 脑内出血。

DESCRIPTION (provided by applicant): Acute primary non-traumatic intracerebral hemorrhage (ICH) is a common disorder for which there is currently no therapy of proven benefit in improving mortality and functional outcome. In fact, there remains controversy regarding the mechanisms by which ICH creates primary and secondary brain injury. The overall objective of this proposal is to produce a program which combines didactic teaching, mentoring, and clinical research to build upon Dr. Hemphill's training in neurologic critical care, thereby allowing him to develop into an independent clinical investigator studying mechanisms of injury and treatment of ICH. While management decisions in ischemic stroke, head trauma, and subarachnoid hemorrhage may be made based on clinical and diagnostic monitoring for secondary brain injury, the usefulness of this in ICH is not known. The overall hypothesis for this project is that secondary brain injury adversely effects outcome after ICH and that approaches that decrease secondary brain injury after ICH will improve outcome. This will be investigated through a series of studies related to clinical, neuromonitoring, and neuroimaging evaluation of secondary brain injury in ICH, culminating in a pilot clinical trial of ICH treatment. Studies will address: 1) the impact of clinical secondary brain insults (systemic hypoxia, hypotension, fever, and seizures) on outcome, 2) the influence of brain tissue hypoxia (measured through direct monitoring of brain tissue oxygen tension in the neurologic intensive care unit) on outcome, 3) the correlation between brain tissue hypoxia and ischemia on dynamic CT perfusion and MR diffusion-weighted imaging, and 4) the feasibility of targeting secondary brain injury in a pilot study of ICH treatment. This research should provide new and important information about the role of secondary brain injury in ICH. In conjunction with the didactic training and mentoring undertaken, this program will foster Dr. Hemphill's development into an independent researcher in neurologic critical care, specifically focusing on intracerebral hemorrhage.