Aggressive CSF diversion reverses delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: A case report

Jennifer E. Fugate, Alejandro A. Rabinstein, Eelco F.M. Wijdicks, Giuseppe Lanzino

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Background: External ventricular drain (EVD) placement temporarily provides cerebrospinal fluid (CSF) diversion and is indicated in patients with aneurysmal subarachnoid hemorrhage (aSAH) to relieve hydrocephalus. Methods: Case report. Results: A 56-year-old woman was admitted to our hospital with aSAH complicated by acute hydrocephalus. An EVD was placed and set to 15 mmHg. After nearly 72 h, she clinically deteriorated. A computed tomography (CT) perfusion scan showed hypoperfusion in the watershed regions in both hemispheres and CT angiogram showed mild segmental arterial narrowings. After the EVD was lowered to 5 mmHg, the radiologic perfusion abnormalities and clinical symptoms resolved. Conclusions: We postulate a mechanism by which CSF diversion could decrease the risk of delayed cerebral ischemia after aSAH: CSF drainage at low levels of intracranial pressure (e.g., 5 mmHg) could improve blood flow in the microcirculation, and thus improve tissue perfusion.

Original languageEnglish (US)
Pages (from-to)112-116
Number of pages5
JournalNeurocritical care
Volume17
Issue number1
DOIs
StatePublished - Aug 1 2012

Keywords

  • Aneurysm
  • CSF diversion
  • Delayed cerebral ischemia
  • External ventricular drain
  • Hydrocephalus
  • Subarachnoid hemorrhage
  • Vasospasm
  • Ventriculostomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Aggressive CSF diversion reverses delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: A case report'. Together they form a unique fingerprint.

Cite this