CT perfusion evidence of early global cerebral hypoperfusion after aneurysmal subarachnoid hemorrhage with cardiac arrest

Joseph D. Burns, Jeffrey T. Jacob, Patrick H Luetmer, E. F M Wijdicks

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Cardiac arrest and aneurysmal subarachnoid hemorrhage both cause sudden, severe cerebral hypoper- fusion at ictus. Animal studies indicate that the resultant microvascular dysfunction and cerebral perfusion abnormalities are important determinants of the associated cerebral injury in both conditions. Although this suggests that perfusion imaging might be a useful tool for prognostication in patients with these conditions, this hypothesis has not been thoroughly investigated in humans. Methods Case report. Results A 49-year-old man developed cardiac arrest upon rupture of an intracranial aneurysm. When he arrived at our institution 10 h later, he was comatose, had neurogenic hyperventilation, absent corneal reflexes, and continuous multifocal myoclonus. Despite normal intracranial pressure, normal cerebral perfusion pressure, normal flow in the proximal cerebral arteries on CT angiography, and a lack of diffuse cerebral edema, CT perfusion imaging performed 12 h after ictus showed severe, diffuse hypoperfusion. After the development of refractory intracranial hypertension, physiologic support was withdrawn and the patient died. Conclusions Early global cerebral hypoperfusion can be demonstrated by CT perfusion imaging after cardiac arrest associated with high-grade aneurysmal subarachnoid hemorrhage and may be indicative of poor neurologic outcome. CT perfusion should be investigated as a prognostic tool in these conditions.

Original languageEnglish (US)
Pages (from-to)261-264
Number of pages4
JournalNeurocritical Care
Volume12
Issue number2
DOIs
StatePublished - Apr 2010

Fingerprint

Perfusion Imaging
Subarachnoid Hemorrhage
Heart Arrest
Perfusion
Cerebrovascular Circulation
Abnormal Reflexes
Myoclonus
Cerebral Arteries
Intracranial Hypertension
Hyperventilation
Brain Edema
Intracranial Pressure
Intracranial Aneurysm
Coma
Nervous System
Rupture
Wounds and Injuries

Keywords

  • Cardiac arrest
  • CT perfusion
  • Neurologic prognosis
  • Subarachnoid hemorrhage Global cerebral hypoperfusion

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Clinical Neurology

Cite this

CT perfusion evidence of early global cerebral hypoperfusion after aneurysmal subarachnoid hemorrhage with cardiac arrest. / Burns, Joseph D.; Jacob, Jeffrey T.; Luetmer, Patrick H; Wijdicks, E. F M.

In: Neurocritical Care, Vol. 12, No. 2, 04.2010, p. 261-264.

Research output: Contribution to journalArticle

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