Treatment of ischemic cerebrovascular accidents CVA with Hyperbaric Oxygenation

[Lecba ischemickych mozkovych cevnich prihod hyperbaroxii.]
Vnitr Lek 1992 Jul;38(7):645-50 (ISSN: 0042-773X)
Berger J; Emmerova M; Hadravsky M; Kratky M; Vetrovcova J; Berkova E Neurologicka klinika FN Plzen.

The authors present eleven year's experience with comprehensive treatment of patients who suffered an ischemic cerebrovascular attack. This comprises so-called conventional treatment of cerebrovascular attacks and also hyperbaroxia, i.e. administration of oxygen under high partial pressure. The authors used a therapeutic pressure of 0.2 MPa for 90 minutes in individual exposures. Of 31 treated patients 23 improved, i.e. 76%; eight improved slightly, eight significantly and seven substantially. The condition of the remainder did not change.

Conclusion:

Hyperbaric Oxygen Therapy should therefore be used everywhere where this method is available.
Hyperbaric oxygen for brain injury - the rationale behind the myth
Author(s): J Alex ; G Laden ; S C Griffin ; M E Cowen ; A R J Cale ; L Guvendik
Source: Clinical Intensive Care Volume: 13 Number: 2 Page: 57 -- 63
Publisher: BIOS Scientific Publishers Ltd

Abstract:

Brain injury can have serious physical, mental, and socio-economic impact on a patient's life. The type of injury can be either ischaemic or traumatic but the final common pathway is the release of cytokines and activation of the inflammatory cascade and other mediators of cellular injury. The severity of neurological and neuropsychological impairment can be described in two ways, behaviorally and structurally.

Behavioral impairment describes the human condition. A small left-hemispheric central cortical injury, in a patient with left hemisphere dominance, resulting in expressive dysphasia, dominant hand weakness, and eye movement in coordination, is a socio-economic disaster for the patient. Conversely, a larger anterior right frontal lobe injury may go unnoticed, although causing a greater level of tissue destruction. From these examples we can see that the quantity of the tissue damage (structural impairment) does not necessarily correlate with the socio-economic consequences of brain injury.

Treatment of brain injury focuses on trying to remove the cause, restore perfusion, support the metabolic requirement, and limit the inflammatory response and oxidative damage. Hyperbaric oxygen has been used as a therapeutic adjunct in the treatment of brain injured patients. There are both proponents and opponents to this form of therapy. Most published human studies claim a significant and demonstrable improvement in clinical outcome. The results of animal studies indicate that hyperbaric oxygen may have a beneficial effect by inducing tolerance to ischaemia reperfusion injury in the central nervous system. In this review we try to understand the mechanism of this beneficial effect by looking at the effect of hyperbaric oxygen on inflammatory mediators.

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