Impaired Absorption of CSF during Experimental Subarachnoid Hemorrhage: Effects of Blood Components on Vesicular Transport in Arachnoid Villi

Butler, Ann B.; Maffeo, Charles J.; Johnson, Richard F.; Bass, Norman H.

doi:10.1007/978-3-642-67543-0_55

Cited by 13 publications

(9 citation statements)

References 3 publications

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“…This would result in part from saturation of the choroidal and extrachoroidal facilitated transport system for the primary prostaglandins and TXB2,2728 and in part because of impaired clearance through the arachnoid granulations and obstruction to bulk flow of CSF into the dural venous sinuses. 29 The preliminary observations with indomethacin are interesting. Although intravenous injection decreased the concentrations of all measured prostanoids in cisternal CSF, the decrease in PG 6 oxo Fla was very rapid and most dramatic when compared with controls.…”

Section: Discussionmentioning

confidence: 97%

Effects of subarachnoid haemorrhage on intracranial prostaglandins.

Walker¹,

Pickard²,

Smythe³

et al. 1983

Journal of Neurology, Neurosurgery & Psychiatry

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Prostaglandins E2, F2 alpha, 6 oxo F1 alpha and thromboxane B2 increased in cisternal CSF following mock subarachnoid haemorrhage in dogs, particularly PGE2 (X25.5). Concentrations were increased also in lumbar CSF of five patients some 8 days after subarachnoid haemorrhage. Subarachnoid haemorrhage did not alter the production of prostaglandins by dog whole cortex or choroid plexuses in vitro, but production by pooled dissected cerebral arteries of PGE2 was increased and of 6 oxo F1 alpha was decreased. Intravenous indomethacin decreased prostaglandin production by cerebral tissues, and caused a marked decrease in the prostacyclin metabolite in CSF. The implications of our findings for the aetiology of cerebral vasospasm are discussed.

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Section: Discussionmentioning

confidence: 97%

Effects of subarachnoid haemorrhage on intracranial prostaglandins.

Walker¹,

Pickard²,

Smythe³

et al. 1983

Journal of Neurology, Neurosurgery & Psychiatry

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“…27 In fact, the output of CSF from the lumbar drainage systems routinely exceeds the concomitant ventricular output. [3][4][5]7 A complex relationship between elevated ICP and intracranial sinus pressure has been described; in most cases, venous hypertension is observed when ICP is elevated experimentally. 8,26 In the condition of pseudotumor, intracranial hypertension coexists with small ventricular size, as in our patient population.…”

Section: Discussionmentioning

confidence: 99%

Controlled lumbar drainage in pediatric head injury

Hl²,

Wb³

et al. 1995

Journal of Neurosurgery

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A retrospective study of external lumbar subarachnoid drainage in 16 pediatric patients with severe head injuries is presented. All patients had Glasgow Coma Scale scores of 8 or lower at 6 hours postinjury and were initially treated with ventriculostomy. Five patients required surgical evacuation of focal mass lesions. All patients manifested high intracranial pressures (ICPs) refractory to aggressive therapy, including hyperventilation, furosemide, mannitol, and in some cases, artificially induced barbiturate coma. After lumbar drainage was instituted, 14 patients had an abrupt and lasting decrease in ICP, obviating the need for continued medical management of ICP. In no patient did transtentorial or cerebellar herniation occur as a result of lumbar drainage. It was also noted retrospectively that the patients in this study had discernible basilar cisterns on computerized tomography scans. Fourteen patients survived; eight made good recoveries, three are functional with disability, and three have severe disabilities. Two patients died, most likely from uncontrolled ICP before the lumbar drain was placed. It is concluded that controlled external lumbar subarachnoid drainage is a useful treatment for pediatric patients with severe head injury when aggressive medical therapy and ventricular cerebrospinal fluid evacuation have failed to control high ICP. Selected patients with elevated ICP, which may be a function of posttraumatic cerebrospinal fluid circulation disruption and/or white matter cerebral edema, can be treated with this modality, which accesses the cisternal spaces untapped by ventriculostomy.

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“…19], In the condition of pseudotumor, intracranial hypertension coexists with small ventricular size, as in our patient pop ulation. In addition, the sudden introduction of blood into the subarachnoid space as in trauma has been shown ex perimentally to cause intracranial hypertension secondary to an increase in CSF outflow resistance, presumably at the superior sagittal sinus [20,21 ]. A complex relationship between elevated ICP and intracranial sinus pressure has been described; in most cases, venous hypertension is ob served when ICP is elevated experimentally |14], With diffuse pediatric head injury, brain edema and hyperemia must decrease brain compressibility and thus inhibit ven tricular distension despite CSF absorptive difficulties.…”

Section: Resultsmentioning

confidence: 99%

Preliminary Experience with Controlled External Lumbar Drainage in Diffuse Pediatric Head Injury

Baldwin

Rekate²

1991

Pediatr Neurosurg

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Our experience with the use of external lumbar subarachnoid drainage in 5 children with severe diffuse head injuries is presented. All patients had Glasgow Coma Scale scores of 8 or less at 24 h after injury and were initially treated with ventriculostomies. Two children required surgical evacuation of focal mass lesions. Within 72 h of admission, all children manifested high intracranial pressures (ICP) refractory to maximal therapy, including hyperventi-lation, furosemide, mannitol, and barbiturate coma. After the institution of lumbar drainage, 3 of the 5 children had an abrupt and lasting decrease in ICP, obviating the need for continued barbiturates and hyperventilation. Three children survived, 2 of whom made good recoveries; 1 child is functional with disability. ICP varied passively with the height of the drainage bag in these surviving patients. Two patients died, most likely from uncontrolled ICP before the lumbar drain was placed. We conclude that controlled external lumbar subarachnoid drainage is a potentially useful treatment for severe diffuse pediatric head injury when maximal medical therapy and ventricular cerebrospinal fluid (CSF) evacuation have failed to control high ICP. Posttraumatic CSF circulation disruption, white matter cerebral edema, and intracranial venous hypertension can be treated with this modality in the absence of focal mass lesions.

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Impaired Absorption of CSF during Experimental Subarachnoid Hemorrhage: Effects of Blood Components on Vesicular Transport in Arachnoid Villi

Cited by 13 publications

References 3 publications

Effects of subarachnoid haemorrhage on intracranial prostaglandins.

Effects of subarachnoid haemorrhage on intracranial prostaglandins.

Controlled lumbar drainage in pediatric head injury

Preliminary Experience with Controlled External Lumbar Drainage in Diffuse Pediatric Head Injury

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