Document Detail


Abnormal cerebral vasodilation in aneurysmal subarachnoid hemorrhage: use of serial 133Xe cerebral blood flow measurement plus acetazolamide to assess cerebral vasospasm.
MedLine Citation:
PMID:  8410215     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A patient with cerebral vasospasm following subarachnoid hemorrhage (SAH) was investigated by serial measurement of cerebral blood flow (CBF) using the xenon-133 emission tomography method. The CBF was measured before and after acetazolamide injection. On Day 2 after SAH, there was early local hyperperfusion in the middle cerebral artery (MCA) territory, ipsilateral to the left posterior communicating artery aneurysm. The regional CBF of this arterial territory decreased slightly after acetazolamide injection, probably because of vasoplegia and the "steal" phenomenon, and thus surgery was delayed. A right hemiplegia with aphasia and disturbed consciousness occurred 4 days later (on Day 6 after SAH) due to arterial vasospasm, despite treatment with a calcium-channel blocker. The initial hyperemia of the left MCA territory was followed by ischemia. The vasodilation induced by acetazolamide administration was significantly subnormal until Day 13, at which time CBF and vasoreactivity amplitude returned to normal and the patient's clinical condition improved. Surgery on Day 14 and outcome were without complication. It is concluded that serial CBF measurements plus acetazolamide injection are useful for monitoring the development of cerebral vasospasm to determine the most appropriate time for aneurysm surgery.
Authors:
Y R Tran Dinh; G Lot; R Benrabah; O Baroudy; J Cophignon; J Seylaz
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  79     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  1993 Oct 
Date Detail:
Created Date:  1993-11-02     Completed Date:  1993-11-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  490-3     Citation Subset:  AIM; IM    
Affiliation:
Service d'Explorations Fonctionnelles du système Nerveux, Hôpital Lariboisière, Paris, France.
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MeSH Terms
Descriptor/Qualifier:
Acetazolamide / diagnostic use*
Adult
Cerebral Angiography
Cerebrovascular Circulation*
Female
Humans
Intracranial Aneurysm / complications*,  radiography
Ischemic Attack, Transient / diagnosis*,  etiology,  radionuclide imaging
Postpartum Period
Subarachnoid Hemorrhage / etiology*,  physiopathology*
Tomography, Emission-Computed, Single-Photon
Vasodilation*
Xenon Radioisotopes / diagnostic use
Chemical
Reg. No./Substance:
0/Xenon Radioisotopes; 59-66-5/Acetazolamide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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