PMID- 30805844
OWN - NLM
STAT- MEDLINE
DCOM- 20200708
LR  - 20220121
IS  - 1556-0961 (Electronic)
IS  - 1541-6933 (Linking)
VI  - 31
IP  - 2
DP  - 2019 Oct
TI  - Multimodal Regional Brain Monitoring of Tissue Ischemia in Severe Cerebral Venous 
      Sinus Thrombosis.
PG  - 297-303
LID - 10.1007/s12028-019-00695-7 [doi]
AB  - BACKGROUND: Comatose critically ill patients with severe diffuse cerebral venous 
      thrombosis (CVT) are at high risk of secondary hypoxic/ischemic insults, which 
      may considerably worsen neurological recovery. Multimodal brain monitoring (MBM) 
      may therefore improve patient care in this setting, yet no data are available in 
      the literature. METHODS: We report two patients with coma following severe 
      diffuse CVT who underwent emergent invasive MBM with intracranial pressure (ICP), 
      brain tissue oximetry (PbtO(2)), and cerebral microdialysis (CMD). Therapy of CVT 
      consisted of intravenous unfractionated heparin (UFH), followed by endovascular 
      mechanical thrombectomy (EMT). EMT efficacy was assessed continuously at the 
      bedside using MBM. RESULTS: Despite effective therapeutic UFH (aPTT two times 
      baseline levels in the two subjects), average CMD levels of lactate and glucose 
      in the 6 h prior to EMT displayed evidence of regional brain ischemia. The EMT 
      procedure was associated with a rapid (within 6 h) improvement in both CMD 
      lactate (6.42 +/- 0.61 4.89 +/- 0.55 mmol/L, p = 0.02) and glucose (0.49 +/- 0.17 vs. 
      0.96 +/- 0.32 mmol/L, p = 0.0005). EMT was also associated with a significant 
      increase in PbtO(2) (22.9 +/- 7.5 vs. 30.1 +/- 3.6 mmHg, p = 0.0003) and a decrease 
      in CMD glutamate (12.69 +/- 1.06 vs. 5.73 +/- 1.76 mumol/L, p = 0.017) and 
      intracranial pressure (ICP) (13 +/- 4 vs. 11 +/- 4 mmHg (p = 004). Patients did not 
      require surgical decompression, regained consciousness, and were discharged from 
      the hospital with a good neurological outcome (modified Rankin score 3 and 4). 
      CONCLUSIONS: This study illustrates the potential utility of continuous bedside 
      MBM in patients with coma after severe brain injury, irrespective of the primary 
      acute cerebral condition. Despite adequate ICP and PbtO(2) control, the presence 
      of CMD signs of regional brain cell ischemia triggered emergent EMT to treat CVT, 
      which was associated with a significant and clinically relevant improvement of 
      intracerebral physiology.
FAU - Simonin, Alexandre
AU  - Simonin A
AUID- ORCID: 0000-0001-7679-671X
AD  - Neurosurgery, Department of Clinical Neurosciences, University Hospital of 
      Lausanne (CHUV), Rue du Bugnon 21, Lausanne, Switzerland. 
      alexandresimonin21@gmail.com.
FAU - Rusca, Marco
AU  - Rusca M
AD  - Department of Intensive Care Medicine, University Hospital of Lausanne (CHUV), 
      Lausanne, Switzerland.
FAU - Saliou, Guillaume
AU  - Saliou G
AD  - Neuroradiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
FAU - Levivier, Marc
AU  - Levivier M
AD  - Neurosurgery, Department of Clinical Neurosciences, University Hospital of 
      Lausanne (CHUV), Rue du Bugnon 21, Lausanne, Switzerland.
FAU - Daniel, Roy Thomas
AU  - Daniel RT
AD  - Neurosurgery, Department of Clinical Neurosciences, University Hospital of 
      Lausanne (CHUV), Rue du Bugnon 21, Lausanne, Switzerland.
FAU - Oddo, Mauro
AU  - Oddo M
AD  - Department of Intensive Care Medicine, University Hospital of Lausanne (CHUV), 
      Lausanne, Switzerland.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Neurocrit Care
JT  - Neurocritical care
JID - 101156086
RN  - 0 (Anticoagulants)
RN  - 33X04XA5AT (Lactic Acid)
RN  - 9005-49-6 (Heparin)
RN  - IY9XDZ35W2 (Glucose)
RN  - S88TT14065 (Oxygen)
SB  - IM
MH  - Aged
MH  - Anticoagulants/therapeutic use
MH  - Brain
MH  - Brain Ischemia/*diagnosis/etiology/metabolism/therapy
MH  - Cerebral Angiography
MH  - Computed Tomography Angiography
MH  - Endovascular Procedures
MH  - Female
MH  - Glucose/metabolism
MH  - Heparin/therapeutic use
MH  - Humans
MH  - *Intracranial Pressure
MH  - Lactic Acid/metabolism
MH  - Lateral Sinus Thrombosis/complications/diagnostic imaging/metabolism/therapy
MH  - Magnetic Resonance Angiography
MH  - Male
MH  - Microdialysis/*methods
MH  - Middle Aged
MH  - Monitoring, Physiologic/*methods
MH  - Oxygen/metabolism
MH  - Sagittal Sinus Thrombosis/complications/diagnostic imaging/metabolism/therapy
MH  - Sinus Thrombosis, Intracranial/complications/*diagnostic 
      imaging/metabolism/therapy
MH  - Superior Sagittal Sinus/diagnostic imaging
MH  - Thrombectomy/methods
MH  - Tomography, X-Ray Computed
MH  - Transverse Sinuses/diagnostic imaging
OTO - NOTNLM
OT  - Cerebral venous sinus thrombosis
OT  - Endovascular mechanical thrombectomy
OT  - Multimodal brain monitoring
EDAT- 2019/02/26 06:00
MHDA- 2020/07/09 06:00
CRDT- 2019/02/27 06:00
PHST- 2019/02/26 06:00 [pubmed]
PHST- 2020/07/09 06:00 [medline]
PHST- 2019/02/27 06:00 [entrez]
AID - 10.1007/s12028-019-00695-7 [pii]
AID - 10.1007/s12028-019-00695-7 [doi]
PST - ppublish
SO  - Neurocrit Care. 2019 Oct;31(2):297-303. doi: 10.1007/s12028-019-00695-7.