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.

Relationship between hemispheric cerebral blood flow, central conduction time, and clinical grade in aneurysmal subarachnoid hemorrhage

1985 ◽  
Vol 62 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Jacob Rosenstein ◽  
Alexander Dah-Jium Wang ◽  
Lindsay Symon ◽  
Mikio Suzuki
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Initial Slope ◽  
Conduction Time ◽  
Clinical Grade ◽  
Content Type ◽  
Significant Difference ◽  
Fine Print

✓ The relationship between central conduction time (CCT) and hemispheric cerebral blood flow (CBF) has been examined in 20 patients presenting with subarachnoid hemorrhage. A total of 63 combined CCT/CBF recordings were performed at various times throughout the hospital course of these patients, and the findings were correlated to clinical status. The initial-slope index of the CBF (CBFisi) was found to correlate well with clinical grade, and a gradation in flow was noted between the different neurological grades. Patients in Grades I and II (Hunt and Hess classification) had the highest flows (mean CBFisi = 47.2 ± 8.1); Grade III patients had intermediate flows (mean CBFisi = 39.6 ± 7.8); and Grade IV patients had the lowest flows (mean CBFisi = 32.0 ± 6.4). While CCT tended to become increasingly prolonged with worsening grade, a significant difference could not be demonstrated between Grade I, II, and III patients. Only when Grade IV status was reached was the CCT significantly prolonged. When CBFisi and CCT were examined, a threshold relationship was noted between CBFisi and CCT prolongation. At flow values above 30, little change was noted in CCT, and CCT remained in the normal range. However, at flow values below 30, CCT became increasingly prolonged as blood flow diminished. The degree of CCT prolongation appeared to be directly proportional to the degree of blood flow diminution at flows below threshold.

Effect of transluminal angioplasty on cerebral blood flow in the management of symptomatic vasospasm following aneurysmal subarachnoid hemorrhage

1997 ◽  
Vol 86 (5) ◽  
pp. 830-839 ◽  
Author(s):  
Andrew D. Firlik ◽  
Anthony M. Kaufmann ◽  
Charles A. Jungreis ◽  
Howard Yonas
Keyword(s):  
At Risk ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Transluminal Angioplasty ◽  
T Test ◽  
Neurological Deficits ◽  
Symptomatic Vasospasm ◽  
The Mean

✓ In this study the authors have examined the effects of transluminal angioplasty on cerebral blood flow (CBF) in the management of intractable vasospasm following aneurysmal subarachnoid hemorrhage (SAH). Fourteen consecutively enrolled patients underwent attempted angioplasty with or without intraarterial infusion of papaverine. Twelve patients underwent pre- and postangioplasty xenon-enhanced computerized tomography (Xe-CT) scanning to measure regional CBF in 55 to 65 regions of interest (ROIs) per patient. Angioplasty was possible in 13 (93%) of 14 patients, with angiographically demonstrated improvement in all 13. Twelve (92%) of the 13 patients were neurologically improved following angioplasty; seven (58%) of the 12 patients who improved had a complete reversal of all delayed ischemic deficits. Angioplasty significantly decreased the mean number of ROIs at risk (11.4 ROIs pre- and 0.9 ROIs postangioplasty) (p < 0.00005, t-test). All patients had a reduction in the number of ROIs at risk after angioplasty; six (50%) of 12 no longer had any ROIs remaining at risk after angioplasty. Angioplasty significantly increased the mean CBF within at-risk ROIs (13 ml/100 g/minute pre- and 44 ml/100 g/minute postangioplasty) (p < 0.00005, t-test). All patients experienced an improvement in mean CBF in at-risk ROIs after angioplasty, with the mean CBF improving to above 20 ml/100 g/minute in all cases. No differences in the degree of improvement were found in patients who received intraarterial papaverine compared with those who did not. In the majority of patients with refractory vasospasm following SAH, angioplasty effectively dilated spastic arteries, reversed delayed neurological deficits, and significantly improved CBF in areas of brain at risk of infarction.

Biphasic Cerebral Blood Flow Velocity Profile in Patients With Aneurysmal Subarachnoid Hemorrhage

2004 ◽  
Vol 1 (4) ◽  
pp. 455-460 ◽  
Author(s):  
Andreas R. Luft ◽  
Manuel M. Buitrago ◽  
Michel Torbey ◽  
Anish Bhardwaj ◽  
Alexander Razumovsky
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Velocity Profile ◽  
Flow Velocity ◽  
Blood Flow Velocity ◽  
Cerebral Blood Flow Velocity ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Flow Velocity Profile

Acute cerebral blood flow response to dopamine-induced hypertension after subarachnoid hemorrhage

1994 ◽  
Vol 80 (5) ◽  
pp. 857-864 ◽  
Author(s):  
Joseph M. Darby ◽  
Howard Yonas ◽  
Elizabeth C. Marks ◽  
Susan Durham ◽  
Robert W. Snyder ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Systemic Blood Pressure ◽  
Content Type ◽  
Arterial Blood ◽  
Induced Hypertension ◽  
Fine Print

✓ The effects of dopamine-induced hypertension on local cerebral blood flow (CBF) were investigated in 13 patients suspected of suffering clinical vasospasm after aneurysmal subarachnoid hemorrhage (SAH). The CBF was measured in multiple vascular territories using xenon-enhanced computerized tomography (CT) with and without dopamine-induced hypertension. A territorial local CBF of 25 ml/100 gm/min or less was used to define ischemia and was identified in nine of the 13 patients. Raising mean arterial blood pressure from 90 ± 11 mm Hg to 111 ± 13 mm Hg (p < 0.05) via dopamine administration increased territorial local CBF above the ischemic range in more than 90% of the uninfarcted territories identified on CT while decreasing local CBF in one-third of the nonischemic territories. Overall, the change in local CBF after dopamine-induced hypertension was correlated with resting local CBF at normotension and was unrelated to the change in blood pressure. Of the 13 patients initially suspected of suffering clinical vasospasm, only 54% had identifiable reversible ischemia. The authors conclude that dopamine-induced hypertension is associated with an increase in flow in patients with ischemia after SAH. However, flow changes associated with dopamine-induced hypertension may not be entirely dependent on changes in systemic blood pressure. The direct cerebrovascular effects of dopamine may have important, yet unpredictable, effects on CBF under clinical pathological conditions. Because there is a potential risk of dopamine-induced ischemia, treatment may be best guided by local CBF measurements.

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