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Japanese

ELEVATION OF INTRACRANIAL PRESSURE DURING HEMODIALYSIS : CONTINUOUS MEASUREMENT OF CEREBROSPINAL FLUID PRESSURE IN A PATIENT WITH ACOUSTIC NEURINOMA Yasutaka Kurokawa 1 , Susumu Suzuki 1 , Kazuo Hashi 1 , Teiji Uede 1 , Shigeki Matsumura 1 , Takahisa Kawahara 1 , Izumi Yamaji 2 , Yoshihito Ujike 2 , Masamitsu Kaneko 2 1Department of Neurosurgery, Sapporo Medical College 2Division of Emergency and Critical Care Medicine, Sapporo Medical College Keyword: brain edema , disequilibrium syndrome , hemodialysis , intracranial pressure pp.569-573
Published Date 1990/6/1
DOI https://doi.org/10.11477/mf.1406900066
  • Abstract
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Intracranial pressure (ICP) was continuouslymonitored in a thirty-two-year-old female of acoustic neurinoma complicated with chronic renal failure. Severe headache with vomiting has begun to appear during hemodialysis for several months, prompting a diagnosis of an obstructive hydro-cephalus. Continuous ventricular drainage was placed after admission and changes of ICP were monitored during hemodialysis. Dynamic changes of electrolytes, protein, sugar, urea nitrogen, and creatinine levels in the cerebrospinal fluid (CSF) as well as osmolarity were measured every one hour during the hemodialysis. An increment of ICP started to occur gradually after initiation of hemodialysis reaching the maximum value 23 minutes later. It was spontaneously decreased to the initial level 8 minutes later followed by fluctuations thereafter consisting of the changes of 20 to 30 mmHg.

A remarkable rise in osmotic pressure in CSF has been observed corresponding to the rise of ICP which created a large difference from the blood osmotic pressure that consistently decreased following the onset of hemodialysis. Whereas, the absolute values of all measured factors including electrolytes and urea nitrogen in CSF have de-creased consistently which did not seem to con-tribute intermittent increment of osmotic pressure of CSF. The cause of ICP increment in our case was considered mainly due to increase of water content in the brain tissue caused by the widening of osmotic gradient between the CSF and blood, although the substances responsible to the actual increase of CSF osmotic pressure remained unclear.


Copyright © 1990, Igaku-Shoin Ltd. All rights reserved.

基本情報

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

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