Abstract
Background. Detection of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) in patients with a poor clinical exam is challenging. Brain tissue oxygen tension monitoring (PbtO2) and cerebral microdialysis (CMD) can detect ischemia and metabolic derangements. Our aim was to evaluate efficacy of these modalities in real-time detection of DCI.
Methods. All patients with aSAH who underwent with multimodality monitoring (MMM) with PbtO2 and/or CMD between the years of 2013 and 2015 at our institution were retrospectively studied. Mean PbTO2, lactate to pyruvate ratio (LPR), and glucose over the 24-h period prior to each angiogram for evaluation and treatment of vasospasm were correlated to the extent of vasospasm observed in the hemisphere with the monitors. The average measurements were also compared in the setting of presence and absence of angiographically significant vasospasm.
Results. A total of ten patients with aSAH who underwent MMM were identified. PbtO2 decline correlates with severity of proximal vasospasm (r = −0.66). PbtO2 was significantly lower in the setting of vasospasm (17.6 vs. 25.8, p = 0.003), but LPR (34.5 vs. 26.8, p = 0.1) and glucose (0.8 vs. 1.1, p = 0.6) were not significantly different.
Conclusion. Proximal vasospasm after aSAH is associated with MMM indicator of tissue ischemia and/or metabolic derangement. PbtO2 and CMD help in real-time detection and management of DCI.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Schmidt JM, Ko SB, Helbok R, Kurtz P, Stuart RM, Presciutti M, et al. Cerebral perfusion pressure thresholds for brain tissue hypoxia and metabolic crisis after poor-grade subarachnoid hemorrhage. Stroke. 2011;42:1351–6.
Helbok R, Madineni RC, Schmidt MJ, Kurtz P, Fernandez L, Ko SB, et al. Intracerebral monitoring of silent infarcts after subarachnoid hemorrhage. Neurocrit Care. 2011;14:162–7.
Carrera E, Schmidt JM, Oddo M, Fernandez L, Claassen J, Seder D, et al. Transcranial doppler for predicting delayed cerebral ischemia after subarachnoid hemorrhage. Neurosurgery. 2009;65:316–23; discussion 323-314
Kett-White R, Hutchinson PJ, Al-Rawi PG, Gupta AK, Pickard JD, Kirkpatrick PJ. Adverse cerebral events detected after subarachnoid hemorrhage using brain oxygen and microdialysis probes. Neurosurgery. 2002;50:1213–21; discussion 1221-1212
Schulz MK, Wang LP, Tange M, Bjerre P. Cerebral microdialysis monitoring: Determination of normal and ischemic cerebral metabolisms in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg. 2000;93:808–14.
Sarrafzadeh AS, Haux D, Ludemann L, Amthauer H, Plotkin M, Kuchler I, et al. Cerebral ischemia in aneurysmal subarachnoid hemorrhage: A correlative microdialysis-pet study. Stroke. 2004;35:638–43.
Unterberg AW, Sakowitz OW, Sarrafzadeh AS, Benndorf G, Lanksch WR. Role of bedside microdialysis in the diagnosis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg. 2001;94:740–9.
Deshaies EM, Jacobsen W, Singla A, Li F, Gorji R. Brain tissue oxygen monitoring to assess reperfusion after intra-arterial treatment of aneurysmal subarachnoid hemorrhage-induced cerebral vasospasm: A retrospective study. AJNR Am J Neuroradiol. 2012;33:1411–5.
De Georgia MA. Brain tissue oxygen monitoring in neurocritical care. J Intensive Care Med. 2015;30:473–83.
Kassell NF, Helm G, Simmons N, Phillips CD, Cail WS. Treatment of cerebral vasospasm with intra-arterial papaverine. J Neurosurg. 1992;77:848–52.
Firlik AD, Kaufmann AM, Jungreis CA, Yonas H. Effect of transluminal angioplasty on cerebral blood flow in the management of symptomatic vasospasm following aneurysmal subarachnoid hemorrhage. J Neurosurg. 1997;86:830–9.
Hoelper BM, Hofmann E, Sporleder R, Soldner F, Behr R. Transluminal balloon angioplasty improves brain tissue oxygenation and metabolism in severe vasospasm after aneurysmal subarachnoid hemorrhage: Case report. Neurosurgery. 2003;52:970–4; discussion 974-976
Vajkoczy P, Horn P, Bauhuf C, Munch E, Hubner U, Ing D, et al. Effect of intra-arterial papaverine on regional cerebral blood flow in hemodynamically relevant cerebral vasospasm. Stroke. 2001;32:498–505.
Scalzo F, Liebeskind DS. Perfusion angiography in acute ischemic stroke. Comput Math Methods Med. 2016;2016:2478324.
Conflict of Interest
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Khatibi, K. et al. (2020). Role of Bedside Multimodality Monitoring in the Detection of Cerebral Vasospasm Following Subarachnoid Hemorrhage. In: Martin, R., Boling, W., Chen, G., Zhang, J. (eds) Subarachnoid Hemorrhage. Acta Neurochirurgica Supplement, vol 127. Springer, Cham. https://doi.org/10.1007/978-3-030-04615-6_20
Download citation
DOI: https://doi.org/10.1007/978-3-030-04615-6_20
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-04614-9
Online ISBN: 978-3-030-04615-6
eBook Packages: MedicineMedicine (R0)