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HEMODILUTIONAL THERAPY IN RAISED INTRACRANIAL PRESSURE: OBSERVATIONS IN A CASE OF CEREBRAL INFARCTION ASSOCIATED WITH POLYCYTHEMIA VERA Suguru Inao 1 , Masahiro Furuse 1 , Kazuo Yoshida 1 , Katsuyoshi Saso 1 , Yoshiki Kaneoke 2 , Yoshimasa Motegi 2 , Hideaki Asai 3 , Tomomitsu Hotta 4 1Department of Neurosurgery, Nakatsugawa Municipal General Hospital 2Neurology, Nakatsugawa Municipal General Hospital 3Neurology and Radiology, Nakatsugawa Municipal General Hospital 4Department of Internal Medicine, Nagoya University school of Medicine pp.219-224
Published Date 1986/3/1
DOI https://doi.org/10.11477/mf.1406205668
  • Abstract
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A 36-year-old man presented with sudden onset of hemorrhagic cerebral infarction in association with polycythemia vera. On admission this patient manifested semicomatous state and left hemiplegia which were gradually progressed. X ray CT de-monstrated a severe hemorrhagic infarction in right MCA territory accompanying marked shift of midline structures. Cerebral angiograms repre-sented occlusion of right MCA showing floating emboli in the internal carotid. Hematocrit value was found to be high as 61.2 per cent. Elevated ICP levels were noted by means of epidural pres-sure monitoring. Deterioration of patient status was considered to be based on impairment of cerebral circulation due to hemostasis by elevated blood viscosity. In addition to administration of mannitol solution, intermittent exsanguinations, 1000 ml in total amount, were performed and hematocrit levels were corrected by hemodilution. Consciousness level was remarkably improved in accordance with reduction of ICP, which well corresponded to values of hematocrit. Level of ICP and tissue perfusion are convinced to be strongly affected by hemorheological factor in the state of raised ICP.


Copyright © 1986, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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