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

doi:10.1007/s12028-012-9723-z

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 journal › Article › peer-review

10 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 language	English (US)
Pages (from-to)	112-116
Number of pages	5
Journal	Neurocritical care
Volume	17
Issue number	1
DOIs	https://doi.org/10.1007/s12028-012-9723-z
State	Published - Aug 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

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title = "Aggressive CSF diversion reverses delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: A case report",

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.",

keywords = "Aneurysm, CSF diversion, Delayed cerebral ischemia, External ventricular drain, Hydrocephalus, Subarachnoid hemorrhage, Vasospasm, Ventriculostomy",

author = "Fugate, {Jennifer E.} and Rabinstein, {Alejandro A.} and Wijdicks, {Eelco F.M.} and Giuseppe Lanzino",

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T2 - A case report

AU - Fugate, Jennifer E.

AU - Rabinstein, Alejandro A.

AU - Wijdicks, Eelco F.M.

AU - Lanzino, Giuseppe

PY - 2012/8

Y1 - 2012/8

N2 - 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.

AB - 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.

KW - Aneurysm

KW - CSF diversion

KW - Delayed cerebral ischemia

KW - External ventricular drain

KW - Hydrocephalus

KW - Subarachnoid hemorrhage

KW - Vasospasm

KW - Ventriculostomy

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

Abstract

Keywords

ASJC Scopus subject areas

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