Document Detail


Transluminal balloon angioplasty improves brain tissue oxygenation and metabolism in severe vasospasm after aneurysmal subarachnoid hemorrhage: case report.
MedLine Citation:
PMID:  12657196     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE AND IMPORTANCE: The effect of transluminal balloon angioplasty on cerebral biochemical monitoring during treatment of severe cerebral vasospasm after subarachnoid hemorrhage (SAH) was investigated. CLINICAL PRESENTATION: In a 36-year-old man, an anterior communicating artery aneurysm caused an SAH (Hunt and Hess Grade IV, Fisher Grade III). After clipping, intraparenchymal monitoring (intracranial pressure, brain tissue oxygen tension [P(ti)O(2)], and microdialysis sampling of extracellular glucose, lactate, pyruvate, and glutamate) was initiated. Flow velocities obtained by transcranial Doppler sonography increased in the internal carotid artery (ICA)/middle cerebral artery bilaterally. INTERVENTION: After a decrease of P(ti)O(2) to less than 2 mm Hg and an increase of the lactate-to-pyruvate ratio to 44 in the territorial region of the left ICA, angiography demonstrated a 70 to 80% stenosis of the left ICA, which was dilated by a temporary occlusion balloon. This maneuver normalized the ICA diameter, P(ti)O(2) increased immediately from 1.5 to 40 mm Hg, the lactate-to-pyruvate ratio decreased from 44 to 30, and extracellular glucose increased from 0.4 to 0.9 mmol/L. No major changes in glutamate or intracranial pressure were seen. In the clinical follow-up, the patient showed a good recovery 6 months after SAH. CONCLUSION: Transluminal balloon angioplasty led to a continuous and effective resolution of cerebral vasospasm observed by sustained, improved cerebral biochemical parameters. Both P(ti)O(2) and lactate-to-pyruvate ratio might provide an early diagnosis of severe cerebral vasospasm after SAH and continuous surveillance of threatened tissue regions after transluminal balloon angioplasty.
Authors:
Bernd Manfred Hoelper; Erich Hofmann; Roland Sporleder; Florian Soldner; Robert Behr
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  52     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-03-26     Completed Date:  2003-07-03     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  970-4; discussion 974-6     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Klinikum Fulda, Academic Hospital of Philips University Marburg, Fulda, Germany. hoelper@online.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Angioplasty, Balloon*
Blood Flow Velocity / physiology
Blood Glucose / metabolism
Brain / blood supply*
Carotid Artery, Internal
Carotid Stenosis / physiopathology,  therapy
Cerebral Angiography
Energy Metabolism / physiology*
Glutamic Acid / metabolism
Humans
Intracranial Aneurysm / surgery*
Lactic Acid / blood
Male
Oxygen Consumption / physiology*
Postoperative Complications / physiopathology,  therapy*
Pyruvic Acid / blood
Subarachnoid Hemorrhage / surgery*
Vasospasm, Intracranial / physiopathology,  therapy*
Chemical
Reg. No./Substance:
0/Blood Glucose; 127-17-3/Pyruvic Acid; 50-21-5/Lactic Acid; 56-86-0/Glutamic Acid

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