Aggressive CSF Diversion Reverses Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage: A Case Report

被引：16

作者：

Fugate, Jennifer E. ^{[2
]}

Rabinstein, Alejandro A. ^{[2
]}

Wijdicks, Eelco F. M. ^{[2
]}

Lanzino, Giuseppe ^{[1
]}

机构：

[1] Mayo Clin, Dept Neurosurg, Rochester, MN 55905 USA

[2] Mayo Clin, Div Crit Care Neurol, Rochester, MN 55905 USA

来源：

NEUROCRITICAL CARE | 2012年 / 17卷 / 01期

关键词：

Subarachnoid hemorrhage; Aneurysm; Hydrocephalus; External ventricular drain; Ventriculostomy; Vasospasm; Delayed cerebral ischemia; CSF diversion; ACUTE HYDROCEPHALUS; BLOOD-FLOW; DRAINAGE; VENTRICULOSTOMY; PRESSURE; RUPTURE;

D O I：

10.1007/s12028-012-9723-z

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

External ventricular drain (EVD) placement temporarily provides cerebrospinal fluid (CSF) diversion and is indicated in patients with aneurysmal subarachnoid hemorrhage (aSAH) to relieve hydrocephalus. Case report. A 56-year-old woman was admitted to our hospital with aSAH complicated by acute hydrocephalus. An EVD was placed and set to 15 mmHg. After nearly 72 h, she clinically deteriorated. A computed tomography (CT) perfusion scan showed hypoperfusion in the watershed regions in both hemispheres and CT angiogram showed mild segmental arterial narrowings. After the EVD was lowered to 5 mmHg, the radiologic perfusion abnormalities and clinical symptoms resolved. We postulate a mechanism by which CSF diversion could decrease the risk of delayed cerebral ischemia after aSAH: CSF drainage at low levels of intracranial pressure (e.g., 5 mmHg) could improve blood flow in the microcirculation, and thus improve tissue perfusion.

引用

页码：112 / 116

页数：5

共 22 条

[1] Predictors of cerebral infarction in patients with aneurysmal subarachnoid hemorrhage [J].

Fergusen, Sherise ;

Macdonald, R. Loch .

NEUROSURGERY, 2007, 60 (04) :658-667

[2] RELATION OF CEREBRAL VASOSPASM TO SUBARACHNOID HEMORRHAGE VISUALIZED BY COMPUTERIZED TOMOGRAPHIC SCANNING [J].

FISHER, CM ;

KISTLER, JP ;

DAVIS, JM .

NEUROSURGERY, 1980, 6 (01) :1-9

[3]

HARTMANN A, 1977, ACTA NEUROL SCAND, V56, P336

[4] SINGLE PHOTON-EMISSION COMPUTED-TOMOGRAPHY IN PATIENTS WITH ACUTE HYDROCEPHALUS OR WITH CEREBRAL-ISCHEMIA AFTER SUBARACHNOID HEMORRHAGE [J].

HASAN, D ;

VANPESKI, J ;

LOEVE, I ;

KRENNING, EP ;

VERMEULEN, M .

JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 1991, 54 (06) :490-493

[5] CEREBRAL BLOOD-FLOW AND ICP PATTERNS IN PATIENTS WITH COMMUNICATING HYDROCEPHALUS AFTER ANEURYSM RUPTURE [J].

HAYASHI, M ;

KOBAYASHI, H ;

KAWANO, H ;

YAMAMOTO, S ;

MAEDA, T .

JOURNAL OF NEUROSURGERY, 1984, 61 (01) :30-36

[6] Risk of rebleeding after treatment of acute hydrocephalus in patients with aneurysmal subarachnoid hemorrhage [J].

Hellingman, Catharine A. ;

van den Bergh, Walter M. ;

Beijer, Inge S. ;

van Dijk, Gert W. ;

Algra, Ale ;

van Gijn, Jan ;

Rinkel, Gabriel J. E. .

STROKE, 2007, 38 (01) :96-99

[7]

Hütter BO, 1998, NEUROSURGERY, V43, P1054

[8] THE INTERNATIONAL-COOPERATIVE-STUDY-ON-THE-TIMING-OF-ANEURYSM-SURGERY .1. OVERALL MANAGEMENT RESULTS [J].

KASSELL, NF ;

TORNER, JC ;

HALEY, EC ;

JANE, JA ;

ADAMS, HP ;

KONGABLE, GL .

JOURNAL OF NEUROSURGERY, 1990, 73 (01) :18-36

[9] THE EFFECT OF CONTINUOUS DRAINAGE OF CEREBROSPINAL-FLUID IN PATIENTS WITH SUBARACHNOID HEMORRHAGE - A RETROSPECTIVE ANALYSIS OF 108 PATIENTS [J].

KASUYA, H ;

SHIMIZU, T ;

KAGAWA, M .

NEUROSURGERY, 1991, 28 (01) :56-59

[10] Continuous and Intermittent CSF Diversion after Subarachnoid Hemorrhage: a Pilot Study [J].

Kim, G. S. ;

Amato, A. ;

James, M. L. ;

Britz, G. W. ;

Zomorodi, A. ;

Graffagnino, C. ;

Zomorodi, M. ;

Olson, DaiWai M. .

NEUROCRITICAL CARE, 2011, 14 (01) :68-72

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