| Transluminal balloon angioplasty improves brain tissue oxygenation and metabolism in severe vasospasm after aneurysmal subarachnoid hemorrhage: case report. | |
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MedLine Citation:
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PMID: 12657196 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Bernd Manfred Hoelper; Erich Hofmann; Roland Sporleder; Florian Soldner; Robert Behr |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Neurosurgery Volume: 52 ISSN: 0148-396X ISO Abbreviation: Neurosurgery Publication Date: 2003 Apr |
Date Detail:
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Created Date: 2003-03-26 Completed Date: 2003-07-03 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 7802914 Medline TA: Neurosurgery Country: United States |
Other Details:
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Languages: eng Pagination: 970-4; discussion 974-6 Citation Subset: IM |
Affiliation:
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Department of Neurosurgery, Klinikum Fulda, Academic Hospital of Philips University Marburg, Fulda, Germany. hoelper@online.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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0/Blood Glucose; 127-17-3/Pyruvic Acid; 50-21-5/Lactic Acid; 56-86-0/Glutamic Acid |
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