Intracranial Pressure, Cerebral Perfusion Pressure, and SPECT in the Management of Patients with SAH Hunt and Hess Grade
The objective of our study was to examine the course of intracranial pressure (ICP) in patients with SAH Hunt and Hess grades I-II and to analyze the relationship between ICP, cerebral perfusion pressure (CPP) and cerebral blood flow (CBF). Twenty-three p
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Intracranial Pressure, Cerebral Perfusion Pressure, and SPECT in the Management of Patients with SAH Hunt and Hess Grades I-II G. Gambardella\ F. De Blasi l , G. Caruso\ A. Zema\ F. Turiano', and D. Collufio 2 I Department of Neurosurgery, "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy, and 2 Neurosurgical Clinic, University of Messina, Italy
Summary The objective of our study was to examine the course of intracranial pressure (ICP) in patients with SAH Hunt and Hess grades III and to analyze the relationship between ICP, cerebral perfusion pressure (CPP) and cerebral blood flow (CBF). Twenty-three patients were studied. ICP, arterial blood pressure (ABP) and CPP were continuously recorded. The measurements of CBF with single-photon emission computed tomography (SPECT) were performed in fifteen patients, who showed TCD flow velocities exceeding 120 cnIJsec. In the first two days after SAH four patients (15%) showed a normal IeP, six (25%) patients had a moderate increase of ICP ranged from 15 to 25 mm Hg and thirteen (60%) patients had ICP values higher than 25 mm Hg. Seven of these patients, with ICP values higher than 40mm Hg, showed clinical signs of delayed ischaemia. After the treatment with osmotic diuretic, ICP decreased and a clinical improvement was observed with the exception of one patient. In this patient, the SPECT study showed middle cerebral hypoperfusion concordant with the clinically ischaemic hemisphere. Our study showed the utility of the monitoring of these parameters in patients with lower grade SAH, because it allows the modulation of the therapeutic approach and defines the onset of neurological deficits secondary to cerebral ischaemia in all grades of SAH. Keywords: Cerebral haemorrhage.
ischemia;
SPECT:
subarachnoid
Introduction Delayed ischaemic disfunctions (DID) are one of the main complications following subarachnoid haemorrhage (SAH) [10,18]. The pathogenetic mechanisms leading to delayed cerebral ischemia are complex. It is well-known that intracranial pressure (ICP) plays a determinant role in the development of secondary damage. Increased ICP is often observed after SAH, and the resulting reduction of the cerebral perfusion pressure (CPP) is probably the most important factor to consider in the management of
patients with SAH. A number of experimental and clinical studies have correlated the reduction of CPP due to increased ICP and/or decreased arterial blood pressure (ABP) with delayed ischaemia after SAH [2,6,14]. But few studies have compared ICP, CPP, CBF and delayed ischaemia in patients with lower grade SAH. The goal of our study was to examine the course of lCP in patients with SAH Hunt and Hess grades I-II and to analyze the relationship between ICP, CPP, and CBF.
Subjects and Methods Twenty-three consecutive patients (12 females and 11 males) with SAH grades Hunt-Hess I-II admitted to our department were studied. The mean age of patients was 57 + 8 years (range 33 to 71 years). On admission, the CT scan was used to exclude the presence of intraparenchym
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