Vasospasm and Regional Cerebral Blood Flow (rCBF) in Patients with Ruptured Intracranial Aneurysm: Serial rCBF Studies with the Xenon-133 Inhalation Method

Neurosurgery ◽  
1983 ◽  
Vol 13 (4) ◽  
pp. 394-401 ◽  
Author(s):  
Iwao Yamakami ◽  
Katsumi Isobe ◽  
Akira Yamaura ◽  
Takao Nakamura ◽  
Hiroyasu Makino
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Neurological Deficit ◽  
Mean Value ◽  
Initial Slope ◽  
Delayed Ischemic Neurological Deficit ◽  
Ruptured Intracranial Aneurysm ◽  
The Mean ◽  
Xenon 133 ◽  
Head Probe

Abstract To clarify the relationship of vasospasm to the reduction of cerebral blood flow (CBF) and the delayed ischemic neurological deficit, serial rCBF studies with the use of the xenon-133 inhalation method were conducted in 35 postoperative patients with ruptured intracranial aneurysms. The CBF was calculated as an initial slope index (ISI) derived from the desaturation curve of each head probe, and the hemispheric mean value of the ISI (mean ISI) was calculated in both hemispheres. The mean ISI in the hemisphere ipsilateral to the operation was low compared to that of the contralateral hemisphere. In relation to the presence of vasospasm, angiographic findings were classified into the following five types: diffuse, peripheral, proximal-severe, proximal-mild, and no spasm. Patients with vasospasm of the diffuse, peripheral, and proximal-severe types showed a markedly decreased mean ISI, and vasospasm of the diffuse type caused the greatest degree of reduction. The mean ISI of the patients who developed delayed ischemic neurological deficit (DIND) due to vasospasm was significantly decreased (37.4± 4.6) compared to that of the patients who did not develop DIND (52.2± 5.6). None of 3 cases of no spasm and only 1 of 14 cases of proximal-mild spasm developed DIND. On the other hand, all of 4 cases of diffuse, 2 of 3 cases of peripheral, and 2 of 6 cases of proximal-severe spasm developed DIND. Thus, if these three types of vasospasm are joined together as severe vasospasm, 8 of 13 cases with severe vasospasm developed DIND. These results suggest that severe vasospasm causes a reduction of CBF and that the reduced CBF brings about DIND.

Alterations in Cerebral Blood Flow in Preterm Infants with Intraventricular Hemorrhage

PEDIATRICS ◽  
1981 ◽  
Vol 68 (6) ◽  
pp. 763-769
Author(s):  
Laura R. Ment ◽  
Richard A. Ehrenkranz ◽  
Robert C. Lange ◽  
Peter T. Rothstein ◽  
Charles C. Duncan
Keyword(s):  
Computed Tomography ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ct Scan ◽  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Mean Value ◽  
Germinal Matrix ◽  
The Mean ◽  
Xenon 133

Xenon-133 inhalation hemispheric cerebral blood flow (HCBF) determinations at one to two days and four to six days postnatally and at 37 weeks postconceptual age have been correlated with computed tomography (CT) scan and autopsy findings in 15 preterm infants weighing less than 1,250 gm at birth. Ten of these infants had germinal matrix hemorrhages (GMH) or intraventricular hemorrhages (IVH). Although HCBF obtained at one to two days showed no mean difference between the GMH/IVH group and the nonhemorrhage infants, hemispheric flow ratios showed significant discrepancies in the GMH/IVH group. In addition, in four of five patients in whom the hemorrhage appeared asymmetric on CT scan, the side of higher flow correlated with the hemorrhage. At four to six days HCBF showed a lower mean value in the GMH/IVH patients than in the nonhemorrhage patients and differences in the interhemispheric ratios in the GMH/IVH group persisted. There were no differences in the mean HCBF values or hemispheric ratios between the two groups of infants at 37 weeks postconceptual age.

Accuracy of methods for calculating cerebral blood flow from intracarotid xenon-133 injection

1980 ◽  
Vol 238 (5) ◽  
pp. H750-H758
Author(s):  
J. P. Marc-Vergnes ◽  
P. Celsis ◽  
J. P. Charlet ◽  
G. Setien
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Gray Matter ◽  
Relative Weight ◽  
Compartmental Analysis ◽  
Optimization Method ◽  
Initial Slope ◽  
Method Of Calculation ◽  
Blood Flows ◽  
Xenon 133

The accuracy of the three commonly used methods, the initial slope analysis, the stochastic analysis, and the compartmental analysis, for calculating mean cerebral blood flow from xenon-133 clearance curves was studied with the use of computer-generated and real curves. The accuracy of calculation was affected by the cutoff time of the curve, by the level of the compartmental blood flows to white and gray matter and by the ratio of these flow levels, by the relative weight of gray matter, and by the choice of the method of calculation. None of the methods was clearly superior to the others. Each had its own defects that render it more or less suitable for different situations. All three methods generally overestimated mean cerebral blood flow. This overestimation was greater the lower the flow. A curve-fitting index was devised which can be used to check the validity of the bicompartmental model when using compartmental analysis. This same index can provide, though not always, an estimate of the error in the calculation of mean cerebral blood flow when an optimization method is used.

Clinical Use of a Portable Bedside Cerebral Blood Flow Machine in the Management of Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽  
1984 ◽  
Vol 15 (4) ◽  
pp. 519-525 ◽  
Author(s):  
Jacob Rosenstein ◽  
Mikio Suzuki ◽  
Lindsay Symon ◽  
Sheila Redmond
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Initial Slope ◽  
Management Decision ◽  
Mean Flow ◽  
Management Decision Making ◽  
Acute Subarachnoid Hemorrhage ◽  
The Mean

Abstract Recent advances in electronics and microprocessors have enabled the development of a compact portable cerebral blood flow (CBF) machine capable of being transported to the patient's bedside. We have used such a device, the Novo Cerebrograph 2a, during the past 7 months on a regular basis in the day to day management of our patients with intracranial aneurysms. One hundred three studies were performed in 23 cases of suspected intracranial aneurysm. Twenty-two cases presented with acute subarachnoid hemorrhage. Patients were studied on admission, preoperatively, in the recovery room, on postoperative Days 1, 5, and 14, and whenever the clinical condition of the patient warranted. The preoperative admission grade was found to correlate well with the mean CBFisi (ISI: initial slope index). Grade III and IV patients had flows significantly lower than those of Grade I and II patients. Serial CBF measurements proved useful in the management of 18 of 22 cases admitted with acute subarachnoid hemorrhage. Delayed ischemic deficits secondary to vasospasm occurred in 6 cases, with a concomitant average fall in mean flow in the symptomatic hemispheres of 27.9%. After volume expansion, an average increase in flow of 29.7% was noted. Low preoperative flows influenced management decision-making in 8 cases. In a further 4 cases, serial CBF measurements were helpful in the differential diagnosis of new neurological signs.

scholarly journals Chroma-Memo-Flow Technique for Rapid Sequential Analysis of Regional Cerebral Blood Flow (rCBF) Responses

1978 ◽  
Vol 5 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Jørn Overgaard
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Regional Cerebral Blood Flow ◽  
Sequential Analysis ◽  
Initial Slope ◽  
Functional Tests ◽  
Regional Cerebral Blood ◽  
Flow Calculation ◽  
Channel Memory ◽  
Xenon 133

SUMMARY:This is the first report of a method of sequential regional cerebral blood flow (rCBF) analysis, called Croma-Memo-Flow. This technique is a computerized modification of the initial slope method of regional cerebral blood flow (rCBF init.), allowing temporal resolution of the flow pattern by calculation of the slopes of sequential segments of the initial 1-2 minutes of the Xenon-133 washout curve. The same theoretical analysis applies to this method as to the rCBF init. method. Each flow calculation is based on the slope of a discrete 16 second segment of the initial washout; and each second the segment is advanced by one second. A new flow calculation is made each second and is displayed as a color coded map on a TV screen. Each map is labelled, indicating the time in seconds following Xenon injection, and sequential rCBF changes during the clearance period can be immediately visualized. This allows for almost instantaneous analysis and display of rapid or transient rCBF responses to activation and deactivation of the cerebral cortices.The data is stored in a 35 channel memory for deliberate replay, photography, and analysis.Functional tests may be applied during the initial washout period and both the magnitude and chronological relationships of the evoked regional cerebrovascular responses observed. A clinical study is presented to illustrate the possibilities of applying the technique to assess cortical reactivity.

Augmentation of Cerebral Blood Flow Induced by Hemodilution in Stroke Patients after Superficial Temporal-Middle Cerebral Arterial Bypass Operation

Neurosurgery ◽  
1984 ◽  
Vol 15 (4) ◽  
pp. 535-539 ◽  
Author(s):  
James H. Wood ◽  
Konstantinos S. Polyzoidis ◽  
David B. Kee ◽  
Antonio R. Prats ◽  
Gordon L. Gibby ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cerebral Perfusion ◽  
Brain Regions ◽  
Initial Slope ◽  
Homologous Region ◽  
Stroke Patients ◽  
Ischemic Brain ◽  
Bypass Patency ◽  
The Mean

Abstract Experimental hemodilutional therapy has been shown to raise collateral perfusion to acutely ischemic brain regions distal to occluded internal carotid (ICA) and middle cerebral (MCA) arteries and to reduce infarct size. Superficial temporal (STA)-MCA anastomosis surgically establishes additional regional collateralization, and this bypass angiographically enlarges over time. Despite bypass patency verification by Doppler recording made at the edge of the craniectomy, the microsurgical STA-MCA anastomosis in 11 stroke patients did not produce early changes in cerebral perfusion parameters in the MCA territory of either hemisphere as determined by 133xenon inhalation. Therefore, hemodilution was initiated in an effort to increase cerebral perfusion during this marginal period when the STA was beginning to dilate progressively. Incremental venesections with equal intravenous volume replacement with 5% human serum albumin caused a significant lowering of the hematocrit from 40 ± 1 to 33 ± 1%. This isovolemic hemodilutional therapy resulted in significant mean regional cerebral blood flow (rCBF) elevations of 23 ± 5% (SE) in the bypassed MCA territory and of 25 ± 6% in the opposite MCA region. The mean gray flow (F1) in the involved and homologous MCA regions significantly increased 27 ± 8% and 30 ± 11%, respectively. Similarly, the initial slope index (ISI2) significantly rose by 17 ± 5% in the bypassed MCA territory and by 18 ± 6% in the homologous region. These data objectively support the premise that reductions in hematocrit without intravascular volume expansion augment cerebral blood flow, probably by reducing blood viscosity. Moreover, inovolemic hemodilution, the effect of which lasts several weeks, may be useful adjunct therapy for the postoperative care of patients with marginal cerebral circulation who undergo cerebral revascularization.

scholarly journals Noninvasive Method of Estimating Human Newborn Regional Cerebral Blood Flow

1982 ◽  
Vol 2 (4) ◽  
pp. 415-420 ◽  
Author(s):  
D. P. Younkin ◽  
M. Reivich ◽  
J. Jaggi ◽  
W. Obrist ◽  
M. Delivoria-Papadopoulos
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Gray Matter ◽  
Regional Cerebral Blood Flow ◽  
Relative Weight ◽  
Initial Slope ◽  
Noninvasive Method ◽  
Regional Cerebral Blood ◽  
Fractional Flow ◽  
Xenon 133

A noninvasive method of estimating regional cerebral blood flow (rCBF) in premature and full-term babies has been developed. Based on a modification of the xenon-133 inhalation rCBF technique, this method uses eight extracranial NaI scintillation detectors and an i. v. bolus injection of xenon-133 (∼0.5 mCi/kg). Arterial xenon concentration was estimated with an external chest detector. Cerebral blood flow was measured in 15 healthy, neurologically normal premature infants. Using Obrist's method of two-compartment analysis, normal values were calculated for flow in both compartments, relative weight and fractional flow in the first compartment (gray matter), initial slope of gray matter blood flow, mean cerebral blood flow, and initial slope index of mean cerebral blood flow. The application of this technique to newborns, its relative advantages, and its potential uses are discussed.

Effects of Intravascular Volume Expansion on Cerebral Blood Flow in Patients with Ruptured Cerebral Aneurysms

Neurosurgery ◽  
1987 ◽  
Vol 21 (3) ◽  
pp. 303-309 ◽  
Author(s):  
Iwao Yamakami ◽  
Katsumi Isobe ◽  
Akira Yamaura
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Volume Expansion ◽  
Cerebral Aneurysms ◽  
Mean Value ◽  
Initial Slope ◽  
Intravascular Volume ◽  
Symptomatic Vasospasm ◽  
Arterial Blood ◽  
Before And After

Abstract To clarify the effect of intravascular volume expansion on cerebral blood flow (CBF) in patients after subarachnoid hemorrhage (SAH), we performed 55 pairs of regional CBF measurements using the xenon-133 inhalation method before and after volume expansion in 35 patients with ruptured cerebral aneurysms. CBF was calculated as the hemispheric mean value of the initial slope index. To accomplish volume expansion, we transfused 500 ml of 5% human serum albumin in half an hour. After volume expansion with albumin, the hemoglobin value decreased significantly (P < 0.005). Volume expansion did not change the mean arterial blood pressure. During the first 2 weeks after SAH, CBF decreased significantly after volume expansion (P < 0.005). During the 3rd week after SAH and subsequently to the 4th week after SAH, volume expansion produced no change in CBF. In patients with symptomatic vasospasm, CBF decreased significantly after volume expansion (P < 0.005). In patients without symptomatic vasospasm, volume expansion produced no change in CBF. The results of this study suggest that increasing the intravascular volume above normal by volume expansion does not increase CBF or reverse symptomatic vasospasm.

scholarly journals Management of cerebral vasospasm in subarachnoid hemorrhage

2019 ◽  
pp. S58-S66
Author(s):  
Dewi Prahaztuti ◽  
Hanik Badriyah Hidayati ◽  
Achmad Firdaus Sani
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
Adhesion Molecule ◽  
Neurological Deficit ◽  
Medical Management ◽  
Treatment Modalities ◽  
Intercellular Adhesion Molecule ◽  
Delayed Ischemic Neurological Deficit

Subarachnoid hemorrhage (SAH) has been shown to result in cerebral vasospasm at day 4 to day 14, which is the main cause of mortality and morbidity after SAH. Outcome after SAH depends on many factors, including the severity of the event, medical management, and prevention of several serious complications. The principal goal in management of vasospasm after SAH is to prevent delayed ischemic neurological deficit (DIND) by decreasing intracranial pressure (ICP), optimizing cerebral oxygen demand rate and improving cerebral blood flow (CBF). Therapeutic management has been applied to prevent or treat vasospasm, including hemodynamic therapy, and endovascular therapy. Endovascular therapies, including mechanical angioplasty and chemical angioplasty with administration of intra-arterial (IA) vasodilator, have been widely used and given a good outcome. The purpose of this article is to describe the management of vasospasm including medical management and endovascular treatment. This review will describe the treatment modalities and management strategies to treat vasospasm.Abbreviations: SAH – subarachnoid hemorrhage; aSAH – aneurysmal subarachnoid hemorrhage; TCD – transcranial Doppler; ROS – reactive oxygen species; ICAM – intercellular adhesion molecule; VCAM – vascular cell adhesion molecule; IL – interleukin; CTA – computed tomography angiography; MRA – magnetic resonance angiography; CBF – cerebral blood flow; DIND – delayed ischemic neurological deficit; RCT - randomized controlled trialsCitation: Prahaztuti D, Hidayati HB, Sani AF. Management of cerebral vasospasm in subarachnoid hemorrhage. Anaesth Pain & Intensive Care 2018;22(3 Suppl 1):S58-S66.Received: 19 Oct 2018 Reviewed: 4, 11 Nov 2018 Accepted: 12 Nov 2018

The Use of Stable Xenon-Enhanced Computed Tomographic Studies of Cerebral Blood Flow to Define Changes in Cerebral Carbon Dioxide Vasoresponsivity Caused by a Severe Head Injury

Neurosurgery ◽  
1991 ◽  
Vol 29 (6) ◽  
pp. 869-873 ◽  
Author(s):  
Donald W. Marion ◽  
Gerrit J. Bouma
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Head Injury ◽  
Severe Head Injury ◽  
Brain Structures ◽  
Computed Tomographic ◽  
Stable Xenon ◽  
Scale Scores ◽  
The Mean ◽  
Xenon 133

Abstract Previous studies using the xenon-133 cerebral blood flow (CBF) method have documented the impairment of CO2vasoresponsivity after a severe head injury, but only global values can be obtained reliably with this technique. We studied CO2vasoresponsivity using the stable xenon-enhanced computed tomographic CBF method, which provided information about well-defined cortical regions and deep brain structures not available with the xenon-133 method. In 17 patients with admission Glasgow Coma Scale scores of 8 or less, hemispheric CO2vasoresponsivity ranged from 1.3 to 8.5% per mm Hg change in partial CO2pressure. Lobar, cerebellar, basal ganglia, and brain stem CO2vasoresponsivity frequently varied from the mean global value by more than 25%. In all but one patient, local CO2vasoresponsivity in one or more of these areas differed from the mean global value by more than 50%. The greatest variability occurred in patients with acute subdural hematomas and diffuse (bihemispheric) injuries. This variability in CO2vasoresponsivity has important implications for the effective and safe management of intracranial hypertension that frequently accompanies severe head injury.

scholarly journals PET Measured Evoked Cerebral Blood Flow Responses in an Awake Monkey

1991 ◽  
Vol 11 (2) ◽  
pp. 229-235 ◽  
Author(s):  
J. S. Perlmutter ◽  
L. L. Lich ◽  
W. Margenau ◽  
S. Buchholz
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Positive Reinforcement ◽  
Bolus Injection ◽  
Mean Value ◽  
Regional Cerebral Blood ◽  
Positron Emission ◽  
The Mean ◽  
Global Mean ◽  
Subtraction Image

We have developed a method to measure task-related regional cerebral blood flow (BF) responses in an awake, trained monkey using positron emission tomography (PET) and H215O. We trained an animal with operant conditioning using only positive reinforcement to climb unassisted into a modified primate chair that was then positioned in the PET scanner. A special headholder and acrylic skull cap permitted precise placement and accurate repositioning. We measured BF qualitatively with bolus injection of H215O and a 40-s scan. Each session included scans at rest interposed with scans during vibration of a forepaw. Regional responses were identified using subtraction image analysis. After global normalization, a resting image was subtracted on a pixel-by-pixel basis from a comparable image collected during vibration. The region of peak response occurred in contralateral sensorimotor cortex with a mean magnitude of 11.6% (±3.2%) of the global mean value for 10 separate experiments, significantly greater than the mean qualitative BF change (0.4 ± 3.6%; p < 0.00001) in the same region for seven rest-rest pairs. This newly developed technique forms the basis for a wide variety of experiments.

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