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

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

Research output: Contribution to journalArticle

8 Citations (Scopus)

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 2012

Fingerprint

Subarachnoid Hemorrhage
Brain Ischemia
Cerebrospinal Fluid
Perfusion
Hydrocephalus
Tomography
Intracranial Pressure
Microcirculation
Angiography

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

Cite this

Aggressive CSF diversion reverses delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage : A case report. / Fugate, Jennifer E.; Rabinstein, Alejandro; Wijdicks, Eelco F M; Lanzino, Giuseppe.

In: Neurocritical Care, Vol. 17, No. 1, 08.2012, p. 112-116.

Research output: Contribution to journalArticle

Fugate, Jennifer E. ; Rabinstein, Alejandro ; Wijdicks, Eelco F M ; Lanzino, Giuseppe. / Aggressive CSF diversion reverses delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage : A case report. In: Neurocritical Care. 2012 ; Vol. 17, No. 1. pp. 112-116.
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