PMID- 12816269
OWN - NLM
STAT- MEDLINE
DCOM- 20030714
LR  - 20220331
IS  - 0022-3085 (Print)
IS  - 0022-3085 (Linking)
VI  - 98
IP  - 6
DP  - 2003 Jun
TI  - Regional cerebral blood flow monitoring in the diagnosis of delayed ischemia 
      following aneurysmal subarachnoid hemorrhage.
PG  - 1227-34
AB  - OBJECT: The goal of this study was to evaluate regional cerebral blood flow 
      (rCBF) monitoring, performed using thermal-diffusion (TD) flowmetry, as a novel 
      means for the bedside diagnosis of symptomatic vasospasm. METHODS: Fourteen 
      patients with high-grade subarachnoid hemorrhage (SAH) who underwent early clip 
      placement for anterior circulation aneurysms were prospectively entered into the 
      study. Thermal-diffusion microprobes were implanted into the white matter of 
      vascular territories that were deemed at risk for developing symptomatic 
      vasospasm. Data on arterial blood pressure, intracranial pressure, cerebral 
      perfusion pressure, rCBF measurement obtained using a TD probe (TD-rCBF), 
      cerebrovascular resistance (CVR), and blood flow velocities were collected at the 
      patient's bedside. The diagnosis of symptomatic vasospasm was based on the 
      manifestation of a delayed ischemic neurological deficit and/or a reduced 
      territorial level of CBF as assessed using stable Xe-enhanced computerized 
      tomography (CT) scanning in combination with vasospasm demonstrated by 
      angiography. Bedside monitoring of TD-rCBF and CVR allowed the detection of 
      symptomatic vasospasm. In the 10 patients with vasospasm the TD-rCBF decreased 
      from 21 +/- 4 to 9 +/- 1 ml/100 g/min (mean +/- standard error of the mean), 
      whereas in the four other patients the TD-rCBF value remained unchanged (mean 
      TD-rCBF = 25 +/- 4 compared with 21 +/- 4 m/100 g/min). A comparison of the 
      results of TD-rCBF and Xe-enhanced CT studies, as well as the calculation of 
      sensitivities, specificities, predictive values, and likelihood ratios, 
      identified a TD-rCBF value of 15 ml/100 g/min as a reliable cutoff for the 
      diagnosis of symptomatic vasospasm. In addition, TD flowmetry was characterized 
      by a more favorable diagnostic reliability than transcranial Doppler 
      ultrasonography. CONCLUSIONS: Thermal-diffusion flowmetry represents a promising 
      method for the bedside monitoring of patients with SAH to detect symptomatic 
      vasospasm. This is of major clinical interest for patients with high-grade SAH, 
      who often cannot be assessed neurologically.
FAU - Vajkoczy, Peter
AU  - Vajkoczy P
AD  - Department of Neurosurgery, Klinikum Mannheim, University of Heidelberg, 
      Mannheim, Germany. peter.vajkoczy@nch.ma.uni-heidelberg.de
FAU - Horn, Peter
AU  - Horn P
FAU - Thome, Claudius
AU  - Thome C
FAU - Munch, Elke
AU  - Munch E
FAU - Schmiedek, Peter
AU  - Schmiedek P
LA  - eng
PT  - Case Reports
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Neurosurg
JT  - Journal of neurosurgery
JID - 0253357
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Blood Flow Velocity
MH  - Brain/*blood supply
MH  - Cerebral Angiography
MH  - *Cerebrovascular Circulation
MH  - Female
MH  - Hemodynamics/physiology
MH  - Humans
MH  - Intracranial Pressure/physiology
MH  - Male
MH  - Middle Aged
MH  - Point-of-Care Systems
MH  - Prospective Studies
MH  - Rheology/instrumentation
MH  - Severity of Illness Index
MH  - Subarachnoid Hemorrhage/*complications/diagnosis/surgery
MH  - Time Factors
MH  - Tomography, X-Ray Computed/methods
MH  - Ultrasonography, Doppler, Transcranial
MH  - Vasospasm, Intracranial/*diagnosis/*etiology
EDAT- 2003/06/21 05:00
MHDA- 2003/07/15 05:00
CRDT- 2003/06/21 05:00
PHST- 2003/06/21 05:00 [pubmed]
PHST- 2003/07/15 05:00 [medline]
PHST- 2003/06/21 05:00 [entrez]
AID - 10.3171/jns.2003.98.6.1227 [doi]
PST - ppublish
SO  - J Neurosurg. 2003 Jun;98(6):1227-34. doi: 10.3171/jns.2003.98.6.1227.