CONTINUOUS REGIONAL CEREBRAL BLOOD-FLOW MONITORING IN ACUTE CRANIOCEREBRAL TRAUMA

被引:46
作者
DICKMAN, CA
CARTER, LP
BALDWIN, HZ
HARRINGTON, T
TALLMAN, D
机构
[1] BARROW NEUROL INST, DIV NEUROL SURG, 350 W THOMAS RD, PHOENIX, AZ 85013 USA
[2] UNIV ARIZONA, COLL MED, DIV NEUROL SURG, TUCSON, AZ 85721 USA
关键词
CEREBRAL BLOOD FLOW; CEREBRAL EDEMA; HYPEREMIA; INTRACRANIAL PRESSURE; MALIGNANT CEREBRAL SWELLING; VASOSPASM;
D O I
10.1227/00006123-199103000-00026
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Regional cortical cerebral blood flow (rCBF) and intracranial pressure (ICP) were monitored continuously with a combined thermal diffusion probe/ICP monitor in 12 patients (8 men and 4 women; mean age, 31 years; range, 7-65 years) with acute head injuries. The mean Glasgow Coma Scale score at admission was 6 (range, 4-12). The rCBF/ICP probes were placed during surgical procedures (n = 11) or in an intensive care unit (n = 1) for subdural hematomas (n = 7), cerebral contusions (n = 4), and an epidural hematoma (n = 1). No probe-related complications occurred. Reduced CBF often occurred and was often inversely proportional to elevations in ICP. Posttraumatic cerebral arterial vasospasm in one patient was detected by rCBF monitoring and confirmed by angiography. In 6 patients who progressed to brain death, rCBF patterns disappeared, which correlated with their clinical and electroencephalographic examinations. Several patients with severe, diffuse brain injuries and high ICP had hyperemic rCBF patterns. In 2 of these patients, increases in rCBF preceded rises in ICP, which implied loss of autoregulation as a mechanism in the development of malignant cerebral edema. This method of CBF monitoring has not yet been established for clinical decision making. The early detection of ischemic or hyperemic responses by continuous CBF monitoring could hasten intervention aimed at restoring adequate tissue perfusion. The technique could also serve as an index of the efficacy of therapeutic interventions and is suitable to gain more insight into the pathophysiology of head injury, especially the relationship of CBF to ICP.
引用
收藏
页码:467 / 472
页数:6
相关论文
共 34 条
  • [1] DESCRIPTION AND EARLY RESULTS OF AN INTRAVENOUS RADIOISOTOPE TECHNIQUE FOR MEASURING REGIONAL CEREBRAL BLOOD-FLOW IN MAN
    AUSTIN, G
    HORN, N
    HAYWARD, W
    ROUHE, S
    [J]. EUROPEAN NEUROLOGY, 1972, 8 (1-4) : 43 - &
  • [3] DIFFUSE CEREBRAL SWELLING FOLLOWING HEAD-INJURIES IN CHILDREN - THE SYNDROME OF MALIGNANT BRAIN EDEMA
    BRUCE, DA
    ALAVI, A
    BILANIUK, L
    DOLINSKAS, C
    OBRIST, W
    UZZELL, B
    [J]. JOURNAL OF NEUROSURGERY, 1981, 54 (02) : 170 - 178
  • [4] REGIONAL CEREBRAL BLOOD-FLOW, INTRACRANIAL PRESSURE, AND BRAIN METABOLISM IN COMATOSE PATIENTS
    BRUCE, DA
    LANGFITT, TW
    MILLER, JD
    SCHUTZ, H
    VAPALAHTI, MP
    STANEK, A
    GOLDBERG, HI
    [J]. JOURNAL OF NEUROSURGERY, 1973, 38 (02) : 131 - 144
  • [5] CARTER LP, 1984, NEUROSURGERY, V15, P22
  • [6] CARTER LP, 1978, NEUROSURGERY, V2, P223
  • [7] CORTICAL BLOOD-FLOW DURING CRANIOTOMY FOR ANEURYSM
    CARTER, LP
    ERSPAMER, R
    WHITE, WL
    YAMAGATA, S
    [J]. SURGICAL NEUROLOGY, 1982, 17 (03): : 204 - 208
  • [8] CORTICAL BLOOD-FLOW - THERMAL-DIFFUSION VS ISOTOPE CLEARANCE
    CARTER, LP
    ERSPAMER, R
    BRO, WJ
    [J]. STROKE, 1981, 12 (04) : 513 - 518
  • [9] HIGH-DOSE BARBITURATE CONTROL OF ELEVATED INTRACRANIAL-PRESSURE IN PATIENTS WITH SEVERE HEAD-INJURY
    EISENBERG, HM
    FRANKOWSKI, RF
    CONTANT, CF
    MARSHALL, LF
    WALKER, MD
    [J]. JOURNAL OF NEUROSURGERY, 1988, 69 (01) : 15 - 23
  • [10] AUTOREGULATION AND CO2 RESPONSES OF CEREBRAL BLOOD-FLOW IN PATIENTS WITH ACUTE SEVERE HEAD-INJURY
    ENEVOLDSEN, EM
    JENSEN, FT
    [J]. JOURNAL OF NEUROSURGERY, 1978, 48 (05) : 689 - 703