Enhancement of cerebral blood flow using systemic hypertonic saline therapy improves outcome in patients with poor-grade spontaneous subarachnoid hemorrhage

2007 ◽  
Vol 107 (2) ◽  
pp. 274-282 ◽  
Author(s):  
Ming-Yuan Tseng ◽  
Pippa G. Al-Rawi ◽  
Marek Czosnyka ◽  
Peter J. Hutchinson ◽  
Hugh Richards ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Hypertonic Saline ◽  
Ct Scanning ◽  
Contralateral Side ◽  
Maximum Increase ◽  
Poor Grade ◽  
Enhanced Computed Tomography ◽  
Spontaneous Subarachnoid Hemorrhage

Object Systemic administration of 23.5% hypertonic saline enhances cerebral blood flow (CBF) in patients with poor-grade spontaneous subarachnoid hemorrhage (SAH). Whether the increment of change in CBF correlates with changes in autoregulation of CBF or outcome at discharge remains unknown. Methods Thirty-five patients with poor-grade spontaneous SAH received 2 ml/kg 23.5% hypertonic saline intravenously, and they underwent bedside transcranial Doppler (TCD) ultrasonography and intracranial pressure (ICP) monitoring. Seventeen of them underwent Xe-enhanced computed tomography (CT) scanning for measuring CBF. Outcome was assessed using the modified Rankin Scale (mRS) at discharge from the hospital. The data were analyzed using repeated-measurement analysis of variance and Dunnett correction. A comparison was made between patients with favorable and unfavorable outcomes using multivariate logistic regression. Results The authors observed a maximum increase in blood pressure by 10.3% (p <0.05) and cerebral perfusion pressure (CPP) by 21.2% (p <0.01) at 30 minutes, followed by a maximum decrease in ICP by 93.1% (p <0.01) at 60 minutes. Changes in ICP and CPP persisted for longer than 180 and 90 minutes, respectively. The results of TCD ultrasonography showed that the baseline autoregulation was impaired on the ipsilateral side of ruptured aneurysm, and increments in flow velocities were higher and lasted longer on the contralateral side (48.75% compared with 31.96% [p = 0.045] and 180 minutes compared with 90 minutes [p <0.05], respectively). The autoregulation was briefly impaired on the contralateral side during the infusion. A dose-dependent effect of CBF increments on favorable outcome was seen on Xe-CT scans (mRS Score 1–3, odds ratio 1.27 per 1 ml/100 g tissue × min, p = 0.045). Conclusions Bolus systemic hypertonic saline therapy may be used for reversal of cerebral ischemia to normal perfusion in patients with poor-grade SAH.

scholarly journals Effect of Hypertonic Saline on Cerebral Blood Flow in Poor-Grade Patients With Subarachnoid Hemorrhage

Stroke ◽  
2003 ◽  
Vol 34 (6) ◽  
pp. 1389-1396 ◽  
Author(s):  
Ming-Yuan Tseng ◽  
Pippa G. Al-Rawi ◽  
John D. Pickard ◽  
Frank A. Rasulo ◽  
Peter J. Kirkpatrick
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Hypertonic Saline ◽  
Poor Grade

scholarly journals Hypertonic Saline In Patients With Poor-Grade Subarachnoid Hemorrhage Improves Cerebral Blood Flow, Brain Tissue Oxygen, and pH

Stroke ◽  
2010 ◽  
Vol 41 (1) ◽  
pp. 122-128 ◽  
Author(s):  
Pippa G. Al-Rawi ◽  
Ming-Yuan Tseng ◽  
Hugh K. Richards ◽  
Jurgens Nortje ◽  
Ivan Timofeev ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Brain Tissue ◽  
Hypertonic Saline ◽  
Tissue Oxygen ◽  
Poor Grade ◽  
Brain Tissue Oxygen

scholarly journals 17-β Estradiol Can Reduce Secondary Ischemic Damage and Mortality of Subarachnoid Hemorrhage

2001 ◽  
Vol 21 (2) ◽  
pp. 174-181 ◽  
Author(s):  
Shao-Hua Yang ◽  
Zhen He ◽  
Samuel S. Wu ◽  
Yun-Ju He ◽  
Jason Cutright ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Contralateral Side ◽  
Female Rats ◽  
Lesion Volume ◽  
Ischemic Damage ◽  
Ipsilateral Side ◽  
Ischemic Lesion ◽  
Significant Difference

Subarachnoid hemorrhage (SAH) is a unique disorder commonly occurring when an aneurysm ruptures, leading to bleeding and clot formation, with a higher incidence in females. To evaluate the influence of 17-β estradiol (E2) in the outcome of subarachnoid hemorrhage, SAH was induced by endovascular puncture of the intracranial segment of internal carotid artery in 15 intact females (INT), 19 ovariectomized females (OVX), and 13 ovariectomized female rats with E2 replacement (OVX + E2). Cerebral blood flow was recorded before and after SAH. All animals were decapitated immediately after death or 24 hours after SAH for clot area analysis. Brains were sliced and stained with 2,3,5-triphenyltetrazolium chloride (TTC) for secondary ischemic lesion analysis. The cortical cerebral blood flow (CBF), which was measured by a laser–Doppler flowmeter, decreased to 29.6% ± 17.7%, 22.8% ± 8.3%, and 43.5% ± 22.9% on the ipsilateral side ( P = 0.01), and decreased to 63.4% ± 14.1%, 57.4% ± 11.0%, and 66.6% ± 17.9% on the contralateral side ( P = 0.26) in INT, OVX, and OVX + E2, respectively. The subcortical CBF, which were measured by the H2 clearance method, were 7.77 ± 12.03, 7.80 ± 8.65, and 20.58 ± 8.96 mL 100 g−1 min−1 on the ipsilateral side ( P < 0.01), and 21.53 ± 2.94, 25.13 ± 3.01, and 25.30 ± 3.23 mL 100 g−1 min−1 on the contralateral side in INT, OVX, and OVX + E2, respectively. The mortality was 53.3%, 68.4%, and 15.4% in INT, OVX, and OVX + E2, respectively ( P = 0.01), whereas no significant difference in clot area was noted among the groups. The secondary ischemic lesion volume was 9.3% ± 8.4%, 24.3% ± 16.3%, and 7.0% ± 6.4% in INT, OVX, and OVX + E2, respectively ( P < 0.01). This study demonstrated that E2 can reduce the mortality and secondary ischemic damage in a SAH model without affecting the clot volume.

Determination of Irreversible Ischemia by Xenon-Enhanced Computed Tomographic Monitoring of Cerebral Blood Flow in Patients with Symptomatic Vasospasm

Neurosurgery ◽  
1989 ◽  
Vol 24 (3) ◽  
pp. 368-372 ◽  
Author(s):  
Howard Yonas ◽  
Laligam Sekhar ◽  
David W. Johnson ◽  
David Gur
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Neurological Deficits ◽  
Noninvasive Technique ◽  
Computed Tomographic ◽  
Symptomatic Vasospasm ◽  
Cortical Regions ◽  
Enhanced Computed Tomography

Abstract In patients with subarachnoid hemorrhage, delayed neurological deficits, often followed by infarction, are believed to result from ischemia caused by vasospasm. Cerebral blood flow (CBF) data have been useful in predicting the risk of vasospasm in these patients and in distinguishing those deficits caused by vasospasm. Although CBF thresholds for infarction have been established in animals, few clinical studies have correlated CBF values with neurological symptoms and infarction. To assess the sensitivity to ischemia provided by xenon-enhanced computed tomography (Xe/CT) of CBF and to define the clinical significance of specific values that it measures, we compared the clinical, CT, and Xe/CT findings on CBF in 51 patients with subarachnoid hemorrhage caused by ruptured aneurysms. Each patient had 1 to 6 Xe/CT studies. Fourteen patients had symptomatic vasospasm. In all 14, the first post deficit Xe/CT study found abruptly reduced CBF, either regionally or globally. In 9 of these 14 patients, flow values fell below 15 ml/100 g/min in 2 or more adjacent 2-cm cortical regions of interest, and in all 9, concurrent follow-up CT scans showed infarction in these regions. Eight of the 9 had paralysis and a severe sensory deficit. No patient whose CBF remained above 18 ml/100 g/min developed infarction. The blood flow studies caused neither significant complications nor neurological deterioration. The Xe/CT CBF method appears very sensitive to the early detection of symptomatic vasospasm. In most patients with subarachnoid hemorrhage, this noninvasive technique can replace angiography to delineate the location and severity of vasospasm, and may be useful in predicting the development of infarction.

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