In: Nursing
Cerebral insult (insult, weakness, cerebral
palsy) is a sudden neurological deficit caused by disturbance of
brain blood flow. The term includes both ischemic and hemorrhagic
incident. Ischemic cerebral insult happens when a blood clot or
embolus blocks or slows down blood flow in the brain artery, thus
blocking transport of oxygen and glucose that are necessary for
regular function of the brain. It could be also caused by a spasm
of brain arteries, without any obstruction of the arterial flow. In
the brain tissue that has remained without oxygen necrotic damage
or infarction occurs, with consecutive peripheral motoric and
sensory defects. Hemorrhagic form is caused by bleeding and is
therefore also called cerebral hemorrhage, mainly due to the
rupture of brain aneurism or weakened or inflamed brain vessel.
Bleeding causes an increase in intracranial pressure that damages
tissues and cells. This type of brain insult has a mortality of
some 80%.
HBOT lessens brain ischemia and hypoxia, facilitates oxygen
delivery to tissues by lower blood viscosity, lowered aggregation
of thrombocytes and increased elasticity of erythrocytes, lessens
edema of brain tissue affected by infarction, lessens edema of
cells ameliorating their metabolism, enhances oxygenation of cells
in the zone of ischemic shade (ischemic penumbra; the zone between
the zone of infarction and vital tissue containing cells in danger
but alive and could be saved), prevents glycolysis and consecutive
lactic acidosis and maintains metabolic functions of the
jeopardized brain zone.
Brain injury (post-traumatic
encephalopathy):
The treatment of brain injuries is focused on the cascade of events
that occur after an injury: ischemia and tissue edema, an increase
of intracranial pressure, destruction of cells and metabolic and
enzymatic disturbances. The efficiency of the treatment is based on
the possibility of brain tissue recovery. HBOT, together with other
non-surgical options, should be considered as an adjunct to
surgical intervention or as a primary option if surgery could not
or will not be performed for whatever reason.
HBOT causes vasoconstriction thus diminishing blood flow through
the brain and consecutively diminishes edema, whilst enhanced
oxygenation suppresses ischemia and consecutive neural tissue
damage. Lower blood flow lowers the influence of increased blood
pressure. It has been demonstrated that HBOT per se lowers
increased intracranial pressure.
Spinal cord injury:
Key goals of application of HBOT in the treatment of spinal cord
injury are lessening of edema and correction of ischemia. The
development of spinal cord injury includes ischemia of gray matter
and increased blood flow in spinal cord with edema of white matter.
Consecutively, loss of function and paralysis below the level of
injury occur.
If HBOT is applied in the treatment, some neural tissue damage
caused by hemorrhage, not by shearing, is reversible. HBOT lessens
ischemia in the gray matter, lessens edema in the white matter and
corrects biochemical disturbances at the site of spinal cord
injury. Rehabilitation is the most important part of the entire
therapy of a spinal cord injury patient. HBOT increases capacity
for physical exercise in patients with neurologic deficits, lessens
metabolic complications of tiredness, increases lung vital capacity
and lessens muscular spasticity.
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