Induced hypertension for the treatment of cerebral ischemia after subarachnoid hemorrhage. Direct effect on cerebral blood flow
The best treatment for symptomatic cerebral ischemia from presumed vasospasm after aneurysmal subarachnoid hemorrhage remains a matter of controversy. A direct effect of any treatment modality on regional cerebral blood flow has never been documented. In a series of 43 patients operated on for ruptured anterior circulation aneurysms, five patients (11.6%) developed clinical signs of cerebral ischemia postoperatively. In four of those patients, the diagnosis of vasospasm was made with measurements of cerebral blood flow (133Xe inhalation or intravenous injection, 10-16 detectors, cerebral blood flow infinity). Treatment with induced arterial hypertension with phenylephrine was instituted. Hemodilution was instituted in one patient; the other three patients already had hematocrits in the range of 33. Within 1 hour, the cerebral blood flow measurement was repeated to document the effect of treatment. The average pretreatment hemispherical blood flow on the operated side was 18.8 mL/100 g per minute, on the contralateral side 21.0 mL/100 g per minute. With treatment these flows increased to 30.8 and 35.8 mL/100 g per minute, respectively. There was also an immediate and obvious positive clinical effect in all patients. The role of measurement of cerebral blood flow in the clinical management of vasospasm is discussed. We stress the theoretical and practical advances of measurements of cerebral blood flow over cerebral angiography, especially in comatose patients.
- Research Organization:
- Virginia Commonwealth Univ., Richmond
- OSTI ID:
- 5530029
- Journal Information:
- Surg. Neurol. (Tryon, N.C.); (United States), Vol. 4
- Country of Publication:
- United States
- Language:
- English
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BRAIN
BLOOD FLOW
ISCHEMIA
BIOMEDICAL RADIOGRAPHY
BLOOD PRESSURE
DIAGNOSIS
HEMORRHAGE
HYPERTENSION
INHALATION
PATIENTS
THERAPY
VASCULAR DISEASES
XENON 133
BETA DECAY RADIOISOTOPES
BETA-MINUS DECAY RADIOISOTOPES
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CENTRAL NERVOUS SYSTEM
DAYS LIVING RADIOISOTOPES
DIAGNOSTIC TECHNIQUES
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EVEN-ODD NUCLEI
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INTERMEDIATE MASS NUCLEI
INTERNAL CONVERSION RADIOISOTOPES
ISOMERIC TRANSITION ISOTOPES
ISOTOPES
MEDICINE
NERVOUS SYSTEM
NUCLEAR MEDICINE
NUCLEI
ORGANS
PATHOLOGICAL CHANGES
RADIOISOTOPES
RADIOLOGY
SYMPTOMS
XENON ISOTOPES
550602* - Medicine- External Radiation in Diagnostics- (1980-)