Clinical Neuroscience

[The effect of cerebrospinal fluid drainage on middle cerebral artery blood flow velocity in conditions with raised intracarnial pressure]

BARZÓ Pál1, DÓCZI Tamás2, KOPNICZKY Zsolt1, ROTYIS Mária3, BODOSI Mihály1

MARCH 20, 1993

Clinical Neuroscience - 1993;46(03-04)

[Middle cerebral artery (MCA) blood flow velocity and intracranial pressure (ICP) were recorded in 42 patients suffering from raised ICP. A major (ICP25 mmHg) or moderate (251CP15 mmHg) degree of intracranial hypertension was reduced by means of either continuous or intermittent CSF drainage. Measurements of MCA blood flow velocity were carried out with transcranial Doppler sonography (TCD). Three types of reactions were observed with regard to cerebral blood flow velocity (CBFV) changes in response to CSF drainage. Patients in Group 1 demonstrated pressure passive CBFV changes throughout the observed cerebral perfusion pressure (PP) range. In Group 2, cerebrospinal fluid (CSF) drainage brought about a transitory increase in CBFV for a few minutes. In Group 3, the reduction of ICP to the normal level did not influence CBFV at all. The pulsatility index (PI) of the cerebrovascular reserve capacity (CVR), which was highest in Group 1, changed in contrast with the CBFV changes in Groups 1 and 2. The pressure-passive velocity pattern (in Group 1) suggests that the blood vessels were at nearly maximum dilatation and were perhaps failing to constrict properly in response to increased PP. As recovery proceeded (Group 2), the mechanism became effective, thereby reestablishing autoregulation. Whereas clinical signs and computed tomography reveal only the trend of the ICP, TCD provides the possibility of a semi-quantitative evaluation of ICP changes and seems especially promising in the rapid assessment of the efficacy of treatment aimed at ICP reduction.]

AFFILIATIONS

  1. Aneszteziológiai és Intenzív Terápiás Intézet
  2. Pécsi Orvostudományi Egyetem Idegsebészeti Klinika
  3. Szent-Györgyi Albert Orvostudományi Egyetem Idegsebészeti Klinika

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