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The Value of Hemodynamic Measurements in the Early Stage of Subarachnoid Hemorrhage

  • A. Pasqualin
  • A. Talacchi
  • G. Pavesi
Conference paper
Part of the Yearbook of Intensive Care and Emergency Medicine 1993 book series (YEARBOOK, volume 1993)

Abstract

The rupture of a cerebral aneurysm is linked with a reversible derangement of cerebral hemodynamics that can lead to focal or global ischemia, more frequently around the end of the first week after hemorrhage, when the damage caused by the initial bleed has become stable or has already subsided [1]. By an accepted definition, these subacute or delayed ischemic disturbances go under the term of cerebral vasospasm [2], because in this subacute period the cerebral vessels appear generally constricted at angiography [3]. However, the lack of correlation between the extension and severity of angiographical vasospasm and the development of clinical symptoms suggests that vessel constriction is only a secondary or complicating factor, and that the primary cause of these disturbances is an impairment of cerebral perfusion, produced by the initial hemorrhage.

Keywords

Cerebral Blood Flow Subarachnoid Hemorrhage Cerebral Perfusion Intracranial Aneurysm Cerebral Vasospasm 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Weir B, Grace M, Hansen J, Rothberg C (1978) Time course of vasospasm in man. J Neurosurg 48: 173–178PubMedCrossRefGoogle Scholar
  2. 2.
    Kassell NF, Sasaki T, Colohan ART, Nazar G (1985) Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke 16: 562–572PubMedCrossRefGoogle Scholar
  3. 3.
    Saito I, Ueda Y, Sano K (1977) Significance of vasospasm in the treatment of ruptured intracranial aneurysms. J Neurosurg 47: 412–429PubMedCrossRefGoogle Scholar
  4. 4.
    Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6: 1–9PubMedCrossRefGoogle Scholar
  5. 5.
    Pasqualin A. Rosta L, Da Pian R, Cavazzani P, Scienza R (1984) The role of computed tomography in the management of vasospasm following subarachnoid hemorrage. Neurosurgery 15: 344–353PubMedCrossRefGoogle Scholar
  6. 6.
    Grubb RL, Raichle ME, Eichling JO, Gado MH (1977) Effects of subarachnoid hemorrhage on cerebral blood flow, blood volume and oxygen utilization in humans. J Neurosurg 46: 453–466Google Scholar
  7. 7.
    Brawanski A, Gaab MR, Bockhorn J, Haubitz I (1982) Atraumatic rCBF measurement: An aid in the timing of surgery and the management of spasm following SAH. Acta Neurochir 63: 43–51CrossRefGoogle Scholar
  8. 8.
    Brawanski A, Maximilian VA (1985) Utility of non-invasive rCBF measurements in the clinical management of patients with subarachnoid hemorrhage. In: Hartman/Hoyer (eds) Cerebral blood flow and metabolism measurement, Springer-Verlag, Berlin Heidelberg, pp 165–171CrossRefGoogle Scholar
  9. 9.
    Farrar JK, Ferguson GG, Drake CG, Peerless SJ (1985) Xenon-133 CBF measurements in the clinical management of patients with subarachnoid haemorrhage. In: Hartmann/Hoyer (eds) Cerebral blood flow and metabolism measurement, Springer-Verlag, Berlin Heidelberg, pp 161–165CrossRefGoogle Scholar
  10. 10.
    Gelmers HJ, Becks JWF, Journee HL (1979) Regional cerebral blood flow in patients with subarachnoid haemorrhage. Acta Neurochir 47: 245–251CrossRefGoogle Scholar
  11. 11.
    Geraud G, Guell A, Andrieu P, Tremoulet M, Bes A (1985) The prognostic value of atraumatic CBF measurement in subarachnoid hemorrage. In: Hartmann/Hoyer (eds) Cerebral blood flow and metabolism measurement, Springer-Verlag, Berlin Heidelberg, pp 153–159CrossRefGoogle Scholar
  12. 12.
    Knuckney NW, Fox RA, Surveyor I, Stokes BAR (1985) Early cerebral blood flow and computerized tomography in predicting ischemia after cerebral aneurysm rupture. J Neurosurg 62: 850–855CrossRefGoogle Scholar
  13. 13.
    Meyer CHA, Lowe D, Meyer M, Richardson PL, Neil-Dwyer G (1983) Progressive change in cerebral blood flow during the first three weeks after subarachnoid hemorrhage. Neurosurgery 12: 58–76PubMedCrossRefGoogle Scholar
  14. 14.
    Mickey BM, Vorstrup S, Voldby B, Lindewald H, Harmsen A, Lassen NA (1984) Serial measurement of regional cerebral blood flow in patients with SAH using Xe-133 inhalation and emission computerized tomography. J Neurosurg 60: 916–922PubMedCrossRefGoogle Scholar
  15. 15.
    Welch KM, Levine SR, Ewing JR (1986) Viewing stroke pathophysiology: An analysis of contemporary methods. Stroke 17: 1071–1077PubMedCrossRefGoogle Scholar
  16. 16.
    Hino A, Mizukawa N, Tenjin H, et al. (1989) Postoperative hemodynamic and metabolic changes in patients with subarachnoid hemorrhage. Stroke 20: 1504–1510PubMedCrossRefGoogle Scholar
  17. 17.
    Powers WL, Grubb RL Jr, Baker RP, Mintun MA, Raichle ME (1985) Regional cerebral blood flow and metabolism in reversible ischemia due to vasospasm. Determination by positron emission tomography. J Neurosurg 62: 539–546PubMedCrossRefGoogle Scholar
  18. 18.
    Yonas H, Sekhar L, Johnson DW, Gur D (1989) Determination of irreversible ischemia by Xenon-enhanced computed tomographie monitoring of cerebral blood flow in patients with symptomatic vasospasm. Neurosurgery 24: 368–372PubMedCrossRefGoogle Scholar
  19. 19.
    Obrist WD, Thompson HK, Wang HS, Wilkinson WE (1975) Regional cerebral blood flow estimated by Xe-133 inhalation. Stroke 6: 245–256PubMedCrossRefGoogle Scholar
  20. 20.
    Nornes H (1973) The role of intracranial pressure in the arrest of hemorrhage in patients with ruptured intracranial aneurysm. J Neurosurg 39: 226–234PubMedCrossRefGoogle Scholar
  21. 21.
    Kontos HA (1989) Validity of cerebral arterial blood flow calculations from velocity measurements. Stroke 20:1–3Google Scholar
  22. 22.
    Sekhar LN, Welchsler LR, Yonas H, Luyckx K, Obrist W (1988) The value of transcranial Doppler examination in the diagnosis of vasospasm after subarachnoid hemorrhage. Neurosurgery 22: 813–821PubMedCrossRefGoogle Scholar
  23. 23.
    Dernbach PD, Little JR, Jones SC, Ebrahim ZY (1988) Altered cerebral autoregulation and CO reactivity after aneurysmal subarachnoid hemorrhage. Neurosurgery 22: 822–826PubMedCrossRefGoogle Scholar
  24. 24.
    Hassler W, Chioffi F (1988) CO2 reactivity of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Acta Neurochir 98: 167–175CrossRefGoogle Scholar
  25. 25.
    Pickard JD, Matheson M, Patterson J, Wyper D (1980) Prediction of late ischemic complications after cerebral aneurym surgery by the intraoperative measurement of cerebral blood flow. J Neurosurg 53: 305–308PubMedCrossRefGoogle Scholar
  26. 26.
    Voldby B, Enevoldsen EM, Jensen FT (1985) Cerebrovascular reactivity in patients with ruptured intracranial aneurysms. J Neurosurg 62: 59–67PubMedCrossRefGoogle Scholar
  27. 27.
    Aaslid R, Huber P, Nornes H (1984) Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound. J Neurosurg 60: 37–41PubMedCrossRefGoogle Scholar
  28. 28.
    Härders AG, Gilsbach JM (1987) Time course of blood velocities changes related to vasospasm in the circle of Willis measured by transcranial Doppler ultrasound. J Neurosurg 66: 718–728PubMedCrossRefGoogle Scholar
  29. 29.
    Lindegaard KF, Nornes H, Bakke SJ, Sorteberg W, Nakstad P (1989) Cerebral vasospasm: Diagnosis by means of angiography and blood velocity measurements. Acta Neurochir 100: 12–24Google Scholar
  30. 30.
    Romner B, Ljunggren B, Brandt L, Saveland H (1989) Transcranial Doppler sonography within 12 hours after subarachnoid hemorrhage. J Neurosurg 70: 732–736PubMedCrossRefGoogle Scholar
  31. 31.
    Seiler RW, Grolimund P, Aaslid R, Huber P, Nornes H (1986) Cerebral vasospasm evaluated by transcranial ultrasound correlated with clinical grade and CT-visualized subarachnoid hemorrhage. J Neurosurg 64: 594–600PubMedCrossRefGoogle Scholar
  32. 32.
    Seiler RW, Reulen HJ, Huber P, Grolimund P, Ebeling U, Steiger HJ (1988) Outcome of aneurysmal subarachnoid hemorrhage in a hospital population: A prospective study including early Operation, intravenous nimodipine, and transcranial Doppler ultrasound. Neurosurgery 23: 598–604PubMedCrossRefGoogle Scholar
  33. Newell DW, Frady MS, Eskridge JM, Winn HR (1990) Distribution of angiographic vasospasm after subarachnoid hemorrhage: Implications for diagnosis by transcranial Doppler ultrasonography. Neurosurgery 27: 574–577Google Scholar
  34. 34.
    Romner B, Ljunggren B, Brandt L, Saveland H (1990) Correlation of transcranial Doppler sonography findings with timing of aneurysm surgery. J Neurosurg 73: 72–76PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • A. Pasqualin
  • A. Talacchi
  • G. Pavesi

There are no affiliations available

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