IMPAIRED CEREBRAL CIRCULATION AND THE EFFECT OF GLYCEROL INFUSION IN THE ACUTE STAGE OF HYPERTENSIVE INTRACEREBRAL HEMATOMA Tohru Yamada 1 , Takeshi Shima 1 , Yoshikazu Okada 1 , Masahiro Nishida 1 , Kanji Yamane 1 , Shinji Okita 1 1Department of Neurosurgery, Chugoku Rousai Hospital Keyword: hypertensive intracrerbral hematoma , cerebral blood flow , glycerol , intracranial pressure pp.303-309
Published Date 1990/3/1
DOI https://doi.org/10.11477/mf.1406900037
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The purpose of the present study was to clarify the mechanism of reduction in cerebral blood flow(CBF) in the acute stage of hypertensive intra-cerebral hematoma and the effect of glycerol in-fusion on the reduced CBF. We examined 55 cases. Thirty-eight cases showed putaminal hema-toma and 17 presented thalamic hematoma. The range of consciousness was from alert to stupor. CBF was measured by single photon emission CT with Xe-133 inhalation within five days after the onset of the hemorrhage. A CBF map was ob-tained at a slice 5 cm above the OM-line and mean CBF of the affected and non-affected hemispheres was calculated. In 20 of 55 cases, 500 ml of gly-cerol was intravenously infused for 60 minutes and thereafter CBF was measured again. Epidural pressure was also recorded at the affected frontal area during glycerol infusion in three of the 20 cases. CBF reduced more profoundly in the area around the hematoma on the CBF map. Mean CBF of the affected hemisphere was negatively correlated with the volume of hematoma by a quadratic regression. After glycerol infusion, 13 of 20 cases showed a significant increase in mean CBF of the affected hemisphere, while the other seven cases showed no increase. Mean CBF in-creased with a higher percentage in cases with ventricular hemorrhage than without ventricular hemorrhage. In three cases where epidural pres-sure was measured during glycerol infusion, mean CBF increased and epidural pressure decreased. The increase in mean CBF was proportional to a rise in perfusion pressure calculated as pressure difference between mean systemic arterial pressure and mean epidural pressure, indicating impaired autoregulation in these cases. More prominent decrease in CBF around the hematoma on the CBF map and the negative correlation between CBF and the volume of hematoma suggest that CBF is reduced mainly by impairment of microcirculation owing to hematoma and surrounding edema in the area around the hematoma. However, it is report-ed by using magnetic resonance imaging that CBF is possibly less influenced by hematoma and edema in the area distant from the hematoma. Thus, in the distant area, CBF appears to be reduced mainly by a decrease in perfusion pressure under impaired autoregulation. On the other hand, glycerol infu-sion was reported to have an effect on cerebrospi-nal fluid (CSF) production and absorption. There-fore, our observation that glycerol infusion was more effective in increasing mean CBF in cases with ventricular hemorrhage suggests that ventri-cular hemorrhage produces serious disturbance in cerebral circulation by reducing CSF clearance and aggravating brain edema, which is effectively improved by glycerol infusion.

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