Serial measurement of regional cerebral blood flow in patients with SAH using 133Xe inhalation and emission computerized tomography

1984 ◽  
Vol 60 (5) ◽  
pp. 916-922 ◽  
Author(s):  
Bruce Mickey ◽  
Sissel Vorstrup ◽  
Bo Voldby ◽  
Helle Lindewald ◽  
Aage Harmsen ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Computerized Tomography ◽  
Cerebral Arteries ◽  
Three Dimensional ◽  
Neurological Deficits ◽  
Content Type ◽  
Serial Measurement ◽  
Regional Flow ◽  
Delayed Neurological Deterioration

✓ A noninvasive three-dimensional method for measuring cerebral blood flow (CBF), xenon-133 inhalation and emission computerized tomography, was used to investigate the CBF changes accompanying delayed neurological deterioration following subarachnoid hemorrhage (SAH). A total of 67 measurements were performed on 20 patients in Hunt and Hess' clinical Grades I to III in the first 21 days post SAH. Five patients with normal CBF tomograms on admission developed delayed neurological deficits in the 2nd week after hemorrhage, at which time repeat CBF tomograms in four patients revealed large areas of well defined regional flow decrease in the vascular territories of the anterior or middle cerebral arteries. Severe vasospasm was noted in three of these patients in whom arteriography was performed in the 2nd week post SAH. Diffuse bihemispheric CBF decreases were noted later in the course of delayed neurological deficits; however, measurements obtained soon after the onset of focal symptoms suggest that the only CBF decreases directly produced by vasospasm in Grade III patients are regional changes.

Early cerebral blood flow and computerized tomography in predicting ischemia after cerebral aneurysm rupture

1985 ◽  
Vol 62 (6) ◽  
pp. 850-855 ◽  
Author(s):  
Neville W. Knuckey ◽  
Richard A. Fox ◽  
Ivor Surveyor ◽  
Bryant A. R. Stokes
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cerebral Ischemia ◽  
Computerized Tomography ◽  
Aneurysm Rupture ◽  
Clinical Grade ◽  
Content Type ◽  
Ruptured Intracranial Aneurysm ◽  
High Incidence ◽  
Subarachnoid Blood

✓ Cerebral blood flow (CBF) was measured during the 1st week of subarachnoid hemorrhage in 46 patients who were in a good clinical grade and had a proven ruptured intracranial aneurysm. The mean initial CBF in patients who developed cerebral ischemia was 42 ml/min−1/l00 gm brain−1, which was significantly lower than in patients who did not develop cerebral ischemia (49 ml/min−1/l00 gm brain−1). This reduced CBF was not secondary to raised intracranial pressure or angiographic spasm. Patients with a reduced CBF (less than 50 ml/min−1/100 gm brain−1) and diffuse subarachnoid blood on computerized tomography had a very high incidence (78%) of cerebral ischemia, despite a good clinical grade at the time of measurement. Serial CBF measurements are of value in monitoring the evolution of cerebral vasospasm.

Endovascular occlusion of intracranial vessels for curative treatment of unclippable aneurysms: report of 16 cases

1991 ◽  
Vol 75 (5) ◽  
pp. 694-701 ◽  
Author(s):  
Jonathan E. Hodes ◽  
Armand Aymard ◽  
Y. Pierre Gobin ◽  
Daniel Rüfenacht ◽  
Siegfried Bien ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cerebral Artery ◽  
Basilar Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Neurological Deficits ◽  
Parent Vessel ◽  
Content Type ◽  
Fine Print

✓ Among 121 intracerebral aneurysms presenting at one institution between 1984 and 1989, 16 were treated by endovascular means. All 16 lesions were intradural and intracranial, and had failed either surgical or endovascular attempts at selective exclusion with parent vessel preservation. The lesions included four giant middle cerebral artery (MCA) aneurysms, one giant anterior communicating artery aneurysm, six giant posterior cerebral artery aneurysms, one posterior inferior cerebellar artery aneurysm, one giant mid-basilar artery aneurysm, two giant fusiform basilar artery aneurysms, and one dissecting vertebral artery aneurysm. One of the 16 patients failed an MCA test occlusion and was approached surgically after attempted endovascular selective occlusion. Treatment involved pretreatment evaluation of cerebral blood flow followed by a preliminary parent vessel test occlusion under neuroleptic analgesia with vigilant neurological monitoring. If the test occlusion was tolerated, it was immediately followed by permanent occlusion of the parent vessel with either detachable or nondetachable balloon or coils. The follow-up period ranged from 1 to 8 years. Excellent outcomes were obtained in 12 cases with complete angiographic obliteration of the aneurysm and no new neurological deficits and/or improvement of the pre-embolization symptoms. Four patients died: two related to the procedure, one secondary to rupture of another untreated aneurysm, and the fourth from a postoperative MCA thrombosis after having failed endovascular test occlusion. The angiographic, clinical, and cerebral blood flow criteria for occlusion tolerance are discussed.

Regional cerebral blood flow and metabolism in reversible ischemia due to vasospasm

1985 ◽  
Vol 62 (4) ◽  
pp. 539-546 ◽  
Author(s):  
William J. Powers ◽  
Robert L. Grubb ◽  
Roy P. Baker ◽  
Mark A. Mintun ◽  
Marcus E. Raichle
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Regional Cerebral Blood Flow ◽  
Emission Tomography ◽  
Neurological Deficits ◽  
Regional Cerebral Blood ◽  
Content Type ◽  
Cerebral Metabolic Rate ◽  
Positron Emission ◽  
Reversible Ischemia

✓ Regional cerebral blood flow (rCBF) and regional cerebral metabolic rate of oxygen (rCMRO2) were measured by positron emission tomography (PET) in four patients with subarachnoid hemorrhage and hemiparesis due to cerebral vasospasm. With resolution of the vasospasm, two patients recovered and two remained hemiparetic. Contralateral to the hemiparesis, rCBF was slightly higher in the two patients who eventually recovered (15.0 and 16.2 ml/100 gm/min) than in the two who remained hemiparetic (12.0 and 11.7 ml/100 gm/min). The rCMRO2 measurements showed similar differences, with values of 1.34 and 2.60 ml/100 gm/min in the patients who recovered, and 0.72 and 1.66 ml/100 gm/min in those who did not. These preliminary findings indicate that with PET studies it may be possible to prospectively differentiate patients with neurological deficits due to reversible ischemia from patients with irreversible infarction.

Cerebral blood flow following induced subarachnoid hemorrhage in the monkey

1972 ◽  
Vol 37 (3) ◽  
pp. 316-324 ◽  
Author(s):  
K. C. Petruk ◽  
G. R. West ◽  
M. R. Marriott ◽  
J. W. McIntyre ◽  
T. R. Overtone ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Perfusion ◽  
Neurological Status ◽  
Neurological Deficits ◽  
Content Type ◽  
Arterial Vasospasm ◽  
Experimental Subarachnoid Hemorrhage ◽  
Angiographic Demonstration

✓ The acute effects of experimental subarachnoid hemorrhage on cerebral blood flow were investigated in 14 adult rhesus monkeys injected with fresh autogenous blood through a needle positioned within the subfrontal subarachnoid space. Cerebral blood flow was measured by the xenon133 tissue clearance method before hemorrhage, and afterward at 30-minute intervals for a 3-hour period. Post-anesthetic neurological status was graded according to Botterell's classification. Twelve monkeys showed a significant decrease in cerebral perfusion, eight displayed focal neurological deficits, and four were moribund. There was a correlation between the degree of impaired circulation and the severity of neurological deficit. Four additional monkeys subjected to subarachnoid acidic saline injection showed no reduction in cerebral blood flow. In three animals cerebral perfusion was increased during the first hour after injection. It is suggested that measurement of cerebral blood flow may be a more valuable prognostic indication of cerebral function and survival than the angiographic demonstration of arterial vasospasm.

Prediction of late ischemic complications after cerebral aneurysm surgery by the intraoperative measurement of cerebral blood flow

1980 ◽  
Vol 53 (3) ◽  
pp. 305-308 ◽  
Author(s):  
John D. Pickard ◽  
Margaret Matheson ◽  
James Patterson ◽  
David Wyper
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cerebral Aneurysm ◽  
Neurological Deficits ◽  
Injection Technique ◽  
Drug Induced ◽  
Induced Hypotension ◽  
Content Type ◽  
Early Use ◽  
Ischemic Complications

✓ The response of cerebral blood flow (CBF) to drug-induced hypotension was measured in 20 patients who underwent craniotomy for clipping of a cerebral aneurysm following subarachnoid hemorrhage. A modified intravenous xenon-133 injection technique was used to monitor CBF. In 15 patients, CBF increased significantly with hypotension, and only one developed a late neurological deficit. In five patients, CBF fell with halothane-induced hypotension, and four developed delayed neurological deficits. Measurement of the intraoperative CBF response to halothane-induced hypotension may reveal those patients at greatest risk of developing late neurological deficits and who require more intensive postoperative monitoring and early use of the induced hypertension technique.

Cerebral blood flow evaluation of prolonged experimental vasospasm

1972 ◽  
Vol 37 (3) ◽  
pp. 302-311 ◽  
Author(s):  
Frederick A. Simeone ◽  
Peter J. Trepper ◽  
Daniel J. Brown
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cerebral Vasospasm ◽  
Cerebral Arteries ◽  
Subsequent Treatment ◽  
Mechanical Trauma ◽  
Content Type ◽  
Control Value ◽  
Treatment Techniques ◽  
Clinical Phenomenon

✓ Prolonged experimental cerebral vasospasm, determined by angiography, can be produced in animals by puncture of an intracranial artery (IAP) or subarachnoid injection of blood (SAI). Following these stimuli, several patterns of blood flow evolve. The biphasic pattern, seen only with hemorrhage from mechanical trauma to the vessel, seems to resemble most closely the clinical phenomenon. Presumably because of autoregulation, only angiographic constriction of cerebral arteries to less than one-half of their control value is associated with significant reduction of cerebral blood flow. Cerebral blood flow recordings and vessel caliber measurements should complement experiments in cerebral vasospasm to ascertain whether the spasm is producing significant ischemia and to assess the efficacy of subsequent treatment techniques.

Experimental vasoconstriction of cerebral arteries by prostaglandins

1972 ◽  
Vol 37 (4) ◽  
pp. 385-397 ◽  
Author(s):  
Y. Lucas Yamamoto ◽  
William Feindel ◽  
Leonhard S. Wolfe ◽  
Hiroko Katoh ◽  
Charles P. Hodge
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Clinical Investigation ◽  
Cerebral Arteries ◽  
Collateral Flow ◽  
Silicon Detectors ◽  
Content Type ◽  
Vertebrobasilar System ◽  
Fluorescein Dye ◽  
Cerebral Circulation Time

✓ Effects of intracarotid infusion of prostaglandins (PG) E1 and F2a on the circulation to the dog brain were examined by fluorescein angiography, by measuring diameter changes in the epicerebral vessels, and by measuring microregional cerebral blood flow with 133xenon and lithium-drift silicon detectors. PGE1 at doses of 0.5 µg/min constricted the epicerebral arteries 700 µ or less in diameter, arrested fluorescein dye injected into the carotid system, and reduced rCBF by 42% with increase of collateral flow to the brain by the vertebrobasilar system. This effect was not obtained by PGE1 to which 0.08% ethanol had been added. PGF2a at doses of 25 µg/min constricted epicerebral arterial vessels less than 200 µ in diameter, reduced rCBF by 35%, and decreased fluorescein dye in the cortical microcirculation with lengthening of the cerebral circulation time. Selective clipping of external and internal carotid arteries indicated that PGE1 acts by constricting these vessels as well as the epicerebral arteries. Since prostaglandins are released from platelets as well as from stimulation of the cerebral cortex they should be considered as factors involved in the regulation of cerebral blood flow and in the mechanism of cerebral vasospasm. These properties of PGE1 and PGF2a also imply the need for caution when these substances are used for clinical investigation.

Vasospasm assessed by angiography and computerized tomography

1979 ◽  
Vol 51 (4) ◽  
pp. 466-475 ◽  
Author(s):  
Isamu Saito ◽  
Taku Shigeno ◽  
Koichi Aritake ◽  
Takeo Tanishima ◽  
Keiji Sano
Keyword(s):  
Computerized Tomography ◽  
Cerebral Arteries ◽  
Neurological Symptoms ◽  
Neurological Deficits ◽  
Low Density ◽  
Content Type ◽  
Density Area ◽  
Middle Cerebral Arteries ◽  
Bilateral Carotid ◽  
Low Density Area

✓ In 44 consecutive cases of ruptured cerebral aneurysm, vasospasm was demonstrated pre- or postoperatively. These cases were examined by bilateral carotid angiography and computerized tomography (CT), and the relationship between the angiographically visualized distribution of vasospasm, the neurological symptoms, and infarction seen on CT was evaluated. Vasospasm occurred in only some intracranial portions of the cerebral arteries that were immersed in blood-stained cerebrospinal fluid. Angiographically, diffuse vasospasm extensively involving bilateral carotid systems indicated the gravest prognosis for patients. Vasospasm affecting one carotid system and the anterior cerebral arteries on the opposite side often produced permanent neurological deficits. On the contrary, when vasospasm was restricted to one carotid system or to bilateral anterior cerebral arteries, it was usually associated with temporary neurological symptoms; however, it always produced residual neurological symptoms if it extended to the ascending branches (M3) of the middle cerebral arteries. Computerized tomography definitely demonstrated a low-density area or infarction in the territory of the spastic arteries in 25 (71%) of 35 cases with vasospasm. A low-density area was always detected when vasospasm occurred in M3 segments.

K-shell fluorescence for the study of regional cerebral blood flow

1971 ◽  
Vol 35 (2) ◽  
pp. 181-184 ◽  
Author(s):  
Robert A. Moody ◽  
Paul B. Hoffer ◽  
Robert E. Polcyn ◽  
Henry J. Lowe ◽  
Alexander Gottschalk ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Transit Time ◽  
Regional Cerebral Blood Flow ◽  
Clearance Time ◽  
Regional Cerebral Blood ◽  
Radioactive Materials ◽  
Content Type ◽  
Regional Flow ◽  
Fine Print

✓ A new method for determining regional cerebral blood flow is reported which utilizes K-shell fluorescence and thus avoids administration of radioactive materials to a patient. Due to its inherent laminographic features, K-shell fluorescence escapes interference from scalp and skull, while giving a true demonstration of regional flow. It is applicable to either clearance time or transit time techniques. The tracer can be administered either by inhalation or intra-arterial injection. The present study demonstrates its feasibility for use in both animals and humans.

Abnormal cerebral vasodilation in aneurysmal subarachnoid hemorrhage: use of serial 133Xe cerebral blood flow measurement plus acetazolamide to assess cerebral vasospasm

1993 ◽  
Vol 79 (4) ◽  
pp. 490-493 ◽  
Author(s):  
Yves Roger Tran Dinh ◽  
Guillaume Lot ◽  
Rabah Benrabah ◽  
Oussama Baroudy ◽  
Jean Cophignon ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
Content Type ◽  
Serial Measurement ◽  
Before And After ◽  
Cerebral Vasodilation

✓ A patient with cerebral vasospasm following subarachnoid hemorrhage (SAH) was investigated by serial measurement of cerebral blood flow (CBF) using the xenon-133 emission tomography method. The CBF was measured before and after acetazolamide injection. On Day 2 after SAH, there was early local hyperperfusion in the middle cerebral artery (MCA) territory, ipsilateral to the left posterior communicating artery aneurysm. The regional CBF of this arterial territory decreased slightly after acetazolamide injection, probably because of vasoplegia and the “steal” phenomenon, and thus surgery was delayed. A right hemiplegia with aphasia and disturbed consciousness occurred 4 days later (on Day 6 after SAH) due to arterial vasospasm, despite treatment with a calcium-channel blocker. The initial hyperemia of the left MCA territory was followed by ischemia. The vasodilation induced by acetazolamide administration was significantly subnormal until Day 13, at which time CBF and vasoreactivity amplitude returned to normal and the patient's clinical condition improved. Surgery on Day 14 and outcome were without complication. It is concluded that serial CBF measurements plus acetazolamide injection are useful for monitoring the development of cerebral vasospasm to determine the most appropriate time for aneurysm surgery.

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