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

被引：15
|
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
收藏
页码：112 / 116
页数：5
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