Induced hypertension for the treatment of cerebral ischemia after subarachnoid hemorrhage. Direct effect on cerebral blood flow

Jan Paul Muizelaar, Donald P. Becker

Research output: Contribution to journalArticle

105 Citations (Scopus)

Abstract

The best treatment for symptomatic cerebral ischemia from presumed vasospasm after aneurysmal subarachnoid hemorrhage remains a matter of controversy. A direct effect of any treatment modality on regional cerebral blood flow has never been documented. In a series of 43 patients operated on for ruptured anterior circulation aneurysms, five patients (11.6%) developed clinical signs of cerebral ischemia postoperatively. In four of those patients, the diagnosis of "vasospasm" was made with measurements of cerebral blood flow (133Xe inhalation or intravenous injection, 10-16 detectors, cerebral blood flow infinity). Treatment with induced arterial hypertension with phenylephrine was instituted. Hemodilution was instituted in one patient; the other three patients already had hematocrits in the range of 33. Within 1 hour, the cerebral blood flow measurement was repeated to document the effect of treatment. The average pretreatment hemispherical blood flow on the operated side was 18.8 mL/100 g per minute, on the contralateral side 21.0 mL/100 g per minute. With treatment these flows increased to 30.8 and 35.8 mI/100 g per minute, respectively. There was also an immediate and obvious positive clinical effect in all patients. The role of measurement of cerebral blood flow in the clinical management of vasospasm is discussed. We stress the theoretical and practical advances of measurements of cerebral blood flow over cerebral angiography, especially in comatose patients.

Original languageEnglish (US)
Pages (from-to)317-325
Number of pages9
JournalSurgical Neurology
Volume25
Issue number4
DOIs
StatePublished - 1986
Externally publishedYes

Fingerprint

Cerebrovascular Circulation
Subarachnoid Hemorrhage
Brain Ischemia
Hypertension
Therapeutics
Cerebral Angiography
Hemodilution
Regional Blood Flow
Phenylephrine
Coma
Hematocrit
Intravenous Injections
Inhalation
Aneurysm

Keywords

  • Cerebral aneurysm
  • Cerebral blood flow
  • Subarachnoid hemorrhage
  • Vasospasm

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Induced hypertension for the treatment of cerebral ischemia after subarachnoid hemorrhage. Direct effect on cerebral blood flow. / Muizelaar, Jan Paul; Becker, Donald P.

In: Surgical Neurology, Vol. 25, No. 4, 1986, p. 317-325.

Research output: Contribution to journalArticle

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