Intracranial pressure changes following aneurysm rupture

Voldby, B; Enevoldsen, E.

doi:10.3171/jns.1982.56.2.0186

Cited by 114 publications

(39 citation statements)

References 37 publications

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“…[1][2][3] When the aneurysm ruptures, intracranial pressure (ICP) abruptly rises, 4 reducing cerebral perfusion and, in many cases, causing temporary intracranial circulatory arrest. Other mechanisms may produce high ICP (HICP) at different times after the initial bleed, including acute and delayed hydrocephalus, global cerebral edema, intracerebral hematoma, cerebral infarction, or impaired cerebral autoregulation.…”

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confidence: 99%

High-Resolution Intracranial Pressure Burden and Outcome in Subarachnoid Hemorrhage

Magni

Pozzi

Rota

et al. 2015

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Even though intracranial hypertension is common after aSAH, only a limited number of studies have assessed the course of ICP and its effects on outcome.10-14 Heuer 10 described the relative frequency of this condition in aSAH; 54% had HICP, including a significant proportion (48.7%) with a good clinical grade compared with the 63.6% who were with a poor grade on admission. HICP was associated with poor outcome, particularly where it did not respond to treatment. In a small microdialysis study, HICP was associated with severely deranged cerebral metabolism, namely a pathological increase in lactate/pyruvate ratio and glutamate and glycerol, probably reflecting secondary brain injury.11 Recently, Zoerle 12 demonstrated that >80% of aSAH patients suffered at least one episode of HICP in the first week, with the highest mean ICP exceeding 20 mm Hg in 36%. The burden of HICP peaked 3 days after subarachnoid hemorrhage and declined after day Background and Purpose-Intracranial pressure (ICP) control is a therapeutic target in patients with aneurysmal subarachnoid hemorrhage, although only a limited number of studies assessed its course and effect on outcome. Pressuretime dose (PTD ICP ) is a method to quantify the burden and the time spent above a defined threshold of ICP. PTD ICP or its relationship with outcome has never been evaluated in aneurysmal subarachnoid hemorrhage. Methods-Analysis of data prospectively collected from aneurysmal subarachnoid hemorrhage patients admitted toNeurointensive Care Unit. Monitored data, including intraparenchymal ICP, were digitally recorded minute-by-minute in the first 7 days. PTD ICP (mm Hg h) was computed using 4 predefined thresholds (15,20, 25, and 30 mm Hg). Outcome was assessed through Extended Glasgow Outcome Scale at hospital discharge and at 6 months. Results-Fifty-five patients were enrolled. Forty-two patients (76%) presented with a poor clinical grade. Overall, mortality was 17% at hospital discharge and 34% at 6 months. Half of patients required extensive therapy to control high ICP during day 1. Median ICP was 10 mm Hg (4-75), whereas median PTD ICP15 , PTD ICP20 , PTD ICP25 , PTD ICP30 were, respectively, 13, 4, 2, and 1 mm Hg h. We observed an association between mortality at hospital discharge and higher level of PTD ICP using 20, 25, and 30 mm Hg as thresholds and between exposure to a moderate-level PTD ICP30 and unfavorable long-term outcome. Conclusions-PTD ICP may better define one of the insults that the brain suffers after aneurysmal rupture, and exposure to moderate PTD ICP30 was significant prognostic factor of 6-month unfavorable outcome.

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High-Resolution Intracranial Pressure Burden and Outcome in Subarachnoid Hemorrhage

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Pozzi

Rota

et al. 2015

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“…Outros observaram somente em 5 de 45 pacientes. 13 Já Voldby e col. 29,30 não mostraram nenhuma alteração da DAVO2 em 31 pacientes com vasoespasmo cerebral. No entanto, o Caso 3 do presente estudo, apesar de não ter sido estudado radiologicamente para demonstrar o clinicamente presente vasoespasmo cerebral, respondeu à terapia específica com melhora clínica e normalização da DAVO2.…”

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Medida da diferença artério-venosa de oxigênio na monitorização de pacientes com hemorragia subaracnóidea por aneurisma cerebral

Pereira¹,

Ramalho²,

Viscardi³

et al. 1997

Arq. Neuro-Psiquiatr.

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RESUMO -A diferença artério-venosa de oxigênio (DAVO2), pelo fato de estar relacionada com o metabolismo cerebral, reflete alterações que ocorrem em determinadas situações patológicas, entre elas as causadas pela hemorragia subaracnóidea espontânea (HSAE). Com a finalidade de avaliar a relação entre alterações na DAVO2 com o quadro clínico e a evolução de pacientes com HSAE, devido à ruptura de aneurisma cerebral, este método foi utilizado em 30 pacientes portadores desta patologia, admitidos na Unidade de Neurocirurgia do HBDF. A HSAE foi confirmada por CT de crânio em 17 pacientes e por punção lombar em 13. Dezoito pacientes foram admitidos com Hunt & Hess (H&H) I ou II, sete com H&H III e cinco com H&H IV ou V. A medida da DAVO2 baseou-se na equação de Fick e os resultados clínicos foram avaliados pela escala de seqüelas de Glasgow. Dezenove pacientes apresentaram DAVO2 normais (inicialmente e durante a evolução), sendo que três faleceram; cinco tiveram valores de DAVO2 sempre baixos e três faleceram; os restantes seis pacientes tiveram valores da DAVO2 sempre elevados e dois faleceram. Os pacientes com DAVO2 normais tiveram melhor evolução clínica e índice de mortalidade menor, quando comparados com os pacientes com valores anormais da DAVO2 (p<0,05). O diagnóstico de vasoespasmo foi feito, em sua maioria, pela avaliação clínica, sendo confirmado radiologicamente em oito pacientes, mas estes últimos tiveram DAVO2 normais. A medida isolada da DAVO2 não foi suficiente para o diagnóstico do vasoespasmo, porém refletiu alterações metabólicas precoces. Baseada nestes resultados, a DAVO2 pode ser usada como parâmetro importante na monitorização da evolução dos pacientes com HSAE. PALAVRAS-CHAVE: hemorragia subaracnóidea espontânea, aneurisma cerebral, vasoespasmo cerebral, fluxo sanguíneo cerebral, diferença artério-venosa de oxigênio (DAV02). Measurement of arteriovenous oxygen difference in the monitoring of patients with subarachnoid haemorrhage due to cerebral aneurysmABSTRACT -The arterious venous oxygen difference (AVDO2) due to the close relationship with cerebral metabolic rate of oxygen and cerebral blood flow shows metabolic alterations that occur in some pathological situations in the brain including subarachnoid haemorrhage. The AVDO2 was calculated by the Fick equation and the results evaluated by the Glasgow outcome scale. Measurements of arteriojugular oxygen difference were carried out in 30 patients with subarachnoid haemorrhage due to rupture of intracranial aneurysms, as an attempt to monitor the relationship between changes in AVDO2, clinical picture, and evolution of the patients. The subarachnoid haemorrhage was diagnosed by CT scan in 17 patients and by lumbar punction in 13 and the diagnosis of arterial vasospasm was carried out by clinical evaluation and confirmed by four vessels angiogram in only eight patients. Eighteen patients were admitted with Hunt & Hess (H&H) I/II, seven with H&H III and five with H&H IV/V. Nineteen patients had AVDO2 normal and this group had three deaths; five pa...

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“…Most investigators have used lumbar CSF for studies of CSF lactate concentrations following SAH, but the lactate values of lumbar CSF are higher than that of cisternal and ventricular CSF due to stagnation of blood in the lumbar sac 2~ Voldby et al 27 reported that ventricular lactate concentrations following SAH correlated fairly well with clinical grading; with intraventricular pressure and prognosis, however, no significant correlations with CSF pH, lactate concentrations and clinical grading were noted. They also described that samples of ventricular CSF probably comprise a mixture of both cisternal and ventricular CSF due to ventricular CSF reflux in patients with impaired CSF flow and absorption following SAH.…”

Section: Discussionmentioning

confidence: 99%

Time course of csf lactate level in subarachnoid haemorrhage correlation with clinical grading and prognosis

et al. 1989

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Cisternal and/or ventricular cerebrospinal fluid (CSF) and arterial blood lactate and acid-base balance were measured serially in 38 patients with aneurysmal subarachnoid haemorrhage (SAH). Based on daily clinical assessment, the patients and accordingly the samples were divided into two groups according to the grading of the World Federation of Neurosurgical Societies (W.F.N.S.). In cisternal CSF, samples of Grade III-V showed significantly higher lactic acidosis than those of Grade I-II. The time course of lactate and pH in poor prognosis groups had a significant tendency of lactic acidosis, especially on the 5th, 6th, 7th day after SAH. Ventricular CSF lactate increased even without CSF acidosis in Groups III-V. Measurement of CSF lactate, especially from the cisterna magna is useful as an indicator of prognosis and changes of intracranial environment following SAH.

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Intracranial pressure changes following aneurysm rupture

Cited by 114 publications

References 37 publications

High-Resolution Intracranial Pressure Burden and Outcome in Subarachnoid Hemorrhage

High-Resolution Intracranial Pressure Burden and Outcome in Subarachnoid Hemorrhage

Medida da diferença artério-venosa de oxigênio na monitorização de pacientes com hemorragia subaracnóidea por aneurisma cerebral

Time course of csf lactate level in subarachnoid haemorrhage correlation with clinical grading and prognosis

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