Relation between brain displacement and local cerebral blood flow in patients with chronic subdural haematoma

Abstract

Objectives-To evaluate the relation between brain displacement, clinical signs and symptoms, and local cerebral blood flow (lCBF) in patients with chronic subdural haematoma (CSDH). Methods-Forty five patients (age range 58-87 years, mean 71.9 (SD 8.4)) with unilateral CSDH were studied. Patients were categorised into three groups: I, headache (n=16); II, paresis (n=14); and III, mental change (n=15). T1 weighted MR images were obtained in all patients preoperatively. Quantitative values of maximum haematoma thickness, midline shift, and brain rotation angle were measured on axial and coronal MR images. In 21 patients, lCBF was measured by Xe enhanced CT. Values for lCBF were obtained in selected regions of interest in the frontal cortex, thalamus, and hemisphere on both the haematoma and contralateral sides. Results-The lCBF reduction in the ipsilateral frontal cortex showed the best linear correlation with haematoma thickness (r=0.57), whereas the reduction in the ipsilateral thalamus had the most significant correlation with pineal shift (r=0.65) and third ventricle incline (r=0.67). In patients with paresis, lCBF decreased significantly on the ipsilateral side of both the frontal cortex and thalamus (p<0.05), whereas patients with mental change showed a significant reduction of lCBF on both sides of the thalamus (p<0.01) and in the ipsilateral frontal cortex (p<0.01). Conclusions-The lCBF reduction and clinical symptoms correlated well with local brain displacement in patients with CSDH. The lCBF in the central cerebral area including the thalamus was reduced in patients with clinical signs. The mental changes found were thought to derive from mild impairment of consciousness due to upper brain stem displacement. (J Neurol Neurosurg Psychiatry 2001;71:741-746)

Diffusion Tensor Imaging in Chronic Subdural Hematoma: Correlation between Clinical Signs and Fractional Anisotropy in the Pyramidal Tract

“…Some previous reports have demonstrated that a reversible reduction of cerebral function can be caused by a decreased cerebral blood flow or vasogenic edema in the affected pyramidal tract; however, the detailed physiology has remained controversial. [13][14][15] In patients with CSDH, our results showed significantly reduced FA in the affected descending pyramidal tract on DTI, correlated with the severity of the motor dysfunction. These findings coincide with those of secondary degeneration caused by stroke, tumor, trauma, and so forth, as demonstrated in previous reports.…”

Intracerebral haemorrhage during surgery for chronic subdural haematoma

“…16,18 This is followed postoperatively by a progressive normalization of blood flow in these areas. [16][17][18] However, it has also been suggested that other factors are required for the development of ICH. One such factor is labile hypertension and resultant changes in blood pressure that occur during decompression, as discussed by D'Avella et al 1 Other factors, such as cerebral amyloid angiopathy, diffuse cerebral atrophy, and fragile cerebral vessels due to ageing, may be important as CSDH occurs frequently in elderly patients.…”

“…1,[7][8][9]12 At present, the most likely explanation for the onset of haematoma formation is a sudden variation in cerebral blood flow as a consequence of cerebral decompression. 1,2,[4][5][6][7][8][9][10][11][12][13][14][15] Xenon-enhanced CT studies have demonstrated that cerebral blood flow in patients with CSDH is diminished, particularly in the ipsilateral frontal cortex, 16 rolandic cortical region, 17 putamen and thalamus. 16,18 This is followed postoperatively by a progressive normalization of blood flow in these areas.…”

“…1,2,[4][5][6][7][8][9][10][11][12][13][14][15] Xenon-enhanced CT studies have demonstrated that cerebral blood flow in patients with CSDH is diminished, particularly in the ipsilateral frontal cortex, 16 rolandic cortical region, 17 putamen and thalamus. 16,18 This is followed postoperatively by a progressive normalization of blood flow in these areas. [16][17][18] However, it has also been suggested that other factors are required for the development of ICH.…”

Chronic Bilateral Subdural Hematoma Complicated by Bilateral Epidural Hematoma Complicating Ventriculo-peritoneal Shunt

“…However, the most important factor, as discussed by several authors [14][15][16] is damage to the cerebral vasculature (diapedesis through the increased permeability of parenchymal blood vessels), secondary to the rapid perioperative parenchymal shift, and a sudden increase in cerebral blood flow combined with focal disruption of autoregulation and cerebral perfusion immediately after surgical decompression [14].…”