التفاصيل البيبلوغرافية
| العنوان: |
Modelling midline shift and ventricle collapse in cerebral oedema following acute ischaemic stroke. |
| المؤلفون: |
Chen, Xi, Józsa, Tamás I., Cardim, Danilo, Robba, Chiara, Czosnyka, Marek, Payne, Stephen J. |
| المصدر: |
PLoS Computational Biology; 5/28/2024, Vol. 20 Issue 5, p1-21, 21p |
| مصطلحات موضوعية: |
CEREBRAL edema, CEREBRAL ventricles, INTRACRANIAL pressure, ISCHEMIC stroke, BRAIN injuries, BLOOD-brain barrier |
| مستخلص: |
In ischaemic stroke, a large reduction in blood supply can lead to the breakdown of the blood-brain barrier and to cerebral oedema after reperfusion therapy. The resulting fluid accumulation in the brain may contribute to a significant rise in intracranial pressure (ICP) and tissue deformation. Changes in the level of ICP are essential for clinical decision-making and therapeutic strategies. However, the measurement of ICP is constrained by clinical techniques and obtaining the exact values of the ICP has proven challenging. In this study, we propose the first computational model for the simulation of cerebral oedema following acute ischaemic stroke for the investigation of ICP and midline shift (MLS) relationship. The model consists of three components for the simulation of healthy blood flow, occluded blood flow and oedema, respectively. The healthy and occluded blood flow components are utilized to obtain oedema core geometry and then imported into the oedema model for the simulation of oedema growth. The simulation results of the model are compared with clinical data from 97 traumatic brain injury patients for the validation of major model parameters. Midline shift has been widely used for the diagnosis, clinical decision-making, and prognosis of oedema patients. Therefore, we focus on quantifying the relationship between ICP and midline shift (MLS) and identify the factors that can affect the ICP-MLS relationship. Three major factors are investigated, including the brain geometry, blood-brain barrier damage severity and the types of oedema (including rare types of oedema). Meanwhile, the two major types (stress and tension/compression) of mechanical brain damage are also presented and the differences in the stress, tension, and compression between the intraparenchymal and periventricular regions are discussed. This work helps to predict ICP precisely and therefore provides improved clinical guidance for the treatment of brain oedema. Author summary: Midline shift has been widely employed in clinical settings to estimate the severity of post-stroke brain oedema. However, the midline shift is affected by many factors and its relationship with intracranial pressure has been proven to vary among patients. In this paper, we utilise a computational tool to investigate the midline shift under large brain deformation from a mechanical perspective. The Augmented Lagrange Method is for the first time employed to solve the large deformation of oedema brains with midline shifts over 5 mm. In the model validation, a reasonable agreement between clinical data and simulation results are obtained. This paper models three different factors that can affect midline shift during oedema development, including brain geometry, blood-brain barrier damage severity and type of oedema. Meanwhile, we discuss the scenarios that can lead to unexpectedly small midline shifts and present quantitative results for a better understanding of brain mechanics during oedema. [ABSTRACT FROM AUTHOR] |
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