Xenon-CT and Transcranial Doppler in Poor-grade or Complicated Aneurysmatic Subarachnoid Hemorrhage Patients Undergoing Aggressive Management of Intracranial Hypertension

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2006 Jun 20

PMID 16783552

Citations 5

Authors

Arturo Chieregato

Giuseppe Sabia

Alessandra Tanfani

Christian Compagnone

Fernanda Tagliaferri

Luigi Targa

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate whether elevated flow velocimetry values are associated with critically reduced cerebral blood flow values in deeply sedated patients with acute aneurysmatic subarachnoid hemorrhage and in whom the detection of clinical vasospasm is not feasible.

Design: Retrospective analysis of prospectively collected data.

Setting: Neurosurgical and trauma patients in an intensive care unit in a regional hospital.

Patients And Participants: Twenty-nine patients in the acute phase following subarachnoid hemorrhage who were sedated and ventilated for elevated intracranial pressure, transcranial Doppler vasospasm, or respiratory failure and were studied with at least a coupled xenon-CT/transcranial Doppler study.

Measurements And Results: Combined measurement and comparison of cerebral blood flow by means of xenon-CT and of mean velocity by means of transcranial Doppler in middle cerebral artery territories. The case mix studied was consistent with patients' predominantly poor grade and with a complicated course. The results suggest that in sedated patients flow velocity and measured cortical mixed cerebral blood flow are not correlated, and, more specifically, that flow velocities values above 120 or 160 cm/s and Lindegaard index above 3 are not associated with an ischemic regional cerebral blood flow. Conversely, as many as 55% of the xenon-CT studies were associated with hyperemia.

Conclusions: In patients with elevated intracranial pressure, mean middle cerebral artery flow velocity or Lindegaard Index does not help to detect critical cerebral blood flow nor elevated cerebral blood flow.

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References

Fox J, Gelb A, Enns J, Murkin J, Farrar J, Manninen P . The responsiveness of cerebral blood flow to changes in arterial carbon dioxide is maintained during propofol-nitrous oxide anesthesia in humans. Anesthesiology. 1992; 77(3):453-6. DOI: 10.1097/00000542-199209000-00008. View

Rosenwasser R, Jallo J, Getch C, Liebman K . Complications of Swan-Ganz catheterization for hemodynamic monitoring in patients with subarachnoid hemorrhage. Neurosurgery. 1995; 37(5):872-5; discussion 875-6. DOI: 10.1227/00006123-199511000-00004. View

HUNT W, Hess R . Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968; 28(1):14-20. DOI: 10.3171/jns.1968.28.1.0014. View

DAmbrosio A, Sughrue M, Yorgason J, Mocco J, Kreiter K, Mayer S . Decompressive hemicraniectomy for poor-grade aneurysmal subarachnoid hemorrhage patients with associated intracerebral hemorrhage: clinical outcome and quality of life assessment. Neurosurgery. 2004; 56(1):12-9. DOI: 10.1227/01.neu.0000144820.38439.63. View

Rothoerl R, Woertgen C, Brawanski A . Hyperemia following aneurysmal subarachnoid hemorrhage: incidence, diagnosis, clinical features, and outcome. Intensive Care Med. 2004; 30(7):1298-302. DOI: 10.1007/s00134-004-2264-y. View

Johansson M, Norback O, Gal G, Cesarini K, Tovi M, Solander S . Clinical outcome after endovascular coil embolization in elderly patients with subarachnoid hemorrhage. Neuroradiology. 2004; 46(5):385-91. DOI: 10.1007/s00234-004-1170-x. View

Mascia L, Fedorko L, terBrugge K, Filippini C, Pizzio M, Ranieri V . The accuracy of transcranial Doppler to detect vasospasm in patients with aneurysmal subarachnoid hemorrhage. Intensive Care Med. 2003; 29(7):1088-94. DOI: 10.1007/s00134-003-1780-5. View

Kelly D, Kordestani R, Martin N, Nguyen T, Hovda D, Bergsneider M . Hyperemia following traumatic brain injury: relationship to intracranial hypertension and outcome. J Neurosurg. 1996; 85(5):762-71. DOI: 10.3171/jns.1996.85.5.0762. View

Goddard A, Raju P, Gholkar A . Does the method of treatment of acutely ruptured intracranial aneurysms influence the incidence and duration of cerebral vasospasm and clinical outcome?. J Neurol Neurosurg Psychiatry. 2004; 75(6):868-72. PMC: 1739081. DOI: 10.1136/jnnp.2003.033068. View

10.

Minhas P, Menon D, Smielewski P, Czosnyka M, Kirkpatrick P, Clark J . Positron emission tomographic cerebral perfusion disturbances and transcranial Doppler findings among patients with neurological deterioration after subarachnoid hemorrhage. Neurosurgery. 2003; 52(5):1017-22; discussion 1022-4. View

11.

Horn P, Vajkoczy P, Bauhuf C, Munch E, Schmiedek P . Quantitative regional cerebral blood flow measurement techniques improve noninvasive detection of cerebrovascular vasospasm after aneurysmal subarachnoid hemorrhage. Cerebrovasc Dis. 2001; 12(3):197-202. DOI: 10.1159/000047704. View

12.

Grosset D, Straiton J, Du Trevou M, Bullock R . Prediction of symptomatic vasospasm after subarachnoid hemorrhage by rapidly increasing transcranial Doppler velocity and cerebral blood flow changes. Stroke. 1992; 23(5):674-9. DOI: 10.1161/01.str.23.5.674. View

13.

Okada Y, Shima T, Nishida M, Yamane K, Hatayama T, Yamanaka C . Comparison of transcranial Doppler investigation of aneurysmal vasospasm with digital subtraction angiographic and clinical findings. Neurosurgery. 1999; 45(3):443-9; discussion 449-50. DOI: 10.1097/00006123-199909000-00005. View

14.

Shen Q, Stuart J, Venkatesh B, Wallace J, Lipman J . Inter observer variability of the transcranial Doppler ultrasound technique: impact of lack of practice on the accuracy of measurement. J Clin Monit Comput. 2003; 15(3-4):179-84. DOI: 10.1023/a:1009925811965. View

15.

Lindegaard K, Nornes H, Bakke S, Sorteberg W, Nakstad P . Cerebral vasospasm after subarachnoid haemorrhage investigated by means of transcranial Doppler ultrasound. Acta Neurochir Suppl (Wien). 1988; 42:81-4. DOI: 10.1007/978-3-7091-8975-7_16. View

16.

van Gijn J, van Dongen K . The time course of aneurysmal haemorrhage on computed tomograms. Neuroradiology. 1982; 23(3):153-6. DOI: 10.1007/BF00347559. View

17.

Darby J, Yonas H, Marks E, Durham S, Snyder R, Nemoto E . Acute cerebral blood flow response to dopamine-induced hypertension after subarachnoid hemorrhage. J Neurosurg. 1994; 80(5):857-64. DOI: 10.3171/jns.1994.80.5.0857. View

18.

Chieregato A, Tagliaferri F, Tanfani A, Cocciolo F, Benedettini W, Compagnone C . Cerebral blood flow in mean cerebral artery low density areas is not always ischemic in patients with aneurysmal subarachnoid hemorrhage--relationship with neurological outcome. Acta Neurochir Suppl. 2006; 95:153-8. DOI: 10.1007/3-211-32318-x_33. View

19.

Yonas H, Sekhar L, Johnson D, Gur D . Determination of irreversible ischemia by xenon-enhanced computed tomographic monitoring of cerebral blood flow in patients with symptomatic vasospasm. Neurosurgery. 1989; 24(3):368-72. DOI: 10.1227/00006123-198903000-00010. View

20.

Smith E, Carter B, Ogilvy C . Proposed use of prophylactic decompressive craniectomy in poor-grade aneurysmal subarachnoid hemorrhage patients presenting with associated large sylvian hematomas. Neurosurgery. 2002; 51(1):117-24; discussion 124. DOI: 10.1097/00006123-200207000-00018. View