Skip to main content
SpringerLink
Log in

Acetazolamide reactivity on cerebral blood flow in patients with subarachnoid haemorrhage

  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

Cerebral vasodilatory capacity was evaluated by acetazolamide-activated N-isopropyl-p-[12 3I]iodoamphetamine (123I-IMP) single photon emission computed tomography (SPECT) in 42 patients with subarachnoid haemorrhage (SAH).

A low perfusion area was present in the corresponding region of haematoma seen on the CT and continued to be noted throughout the time courses. Deteriorated acetazolamide reactivity affected by surgical intervention was seen in 100% of the patients who underwent aneurysm repair in the 1st postoperative week, 92% in the second week, 73% in the third week, and 47% in the fourth week. Three patients with acute diffuse brain swelling seen on CT showed intracranial non-filling of123I-IMP on SPECTs performed on Day 6, and all three died by Day 10.

Some low perfusion areas, due to probable vasospasm, were present in 77% of Hunt and Hess grades I and II patients and in 100% of grades III, IV, and V patients throughout their time courses. Overall, low perfusion areas, due to probable vasospasm, were seen in 10 patients (31%) of 32 who underwent SPECT between Day 4 and 8, 23 (77%) of 30 between Day 9 and 14, 21 (72%) of 29 between Day 15 and 21, and 11 (48%) of 23 between Day 22 and 28.

The results suggest acetazolamide-activated123I-IMP study is of value in evaluating changes in vasodilatory capacity in SAH patients in the acute and subacute stages.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Baron JC, Bousser MG, Comar D, Castaigne P (1980) “Crossed cerebellar diaschisis” in human supratentorial brain infarction. Ann Neurol 8: 128

    Google Scholar 

  2. Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6: 1–9

    PubMed  Google Scholar 

  3. Harders AG, Gilsbach JM (1987) Time course of blood velocity changes related to vasospasm in the circle of Willis measured by transcranial Doppler ultrasound. J Neurosurg 66: 718–728

    PubMed  Google Scholar 

  4. Hasegawa Y, Yamaguchi T, Tsuchiya T, Moriyasu H, Nishimura T (1989) The effect of acetazolamide on electroencephalogram and somatosensory evoked potential in patients with major cerebral artery occlusion. No Socchu 11: 592–599

    Google Scholar 

  5. Hassler W, Chioffi F (1989) CO2 reactivity of cerebral vasospasm after aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 98: 167–175

    Google Scholar 

  6. Højer-Pedersen E (1987) Effect of acetazolamide on cerebral blood flow in subacute and chronic cerebrovascular disease. Stroke 18: 887–891

    PubMed  Google Scholar 

  7. Holl K, Heissler HE, Nemati N, Gaab MR, Haubitz B, Becker H (1990) Die Wirkung der Acetazolamin-induzierten, endogenen Volumenbelastung des zerebrospinalen Systems auf den intrakraniellen Druck. DIAMOX®-Wirkung auf den intrakraniellen Druck (ICP). Neurochirurgia (Stuttg) 33: 29–36

    Google Scholar 

  8. Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28: 14–20

    PubMed  Google Scholar 

  9. Knuckey NW, Fox RA, Surveyor I, Stokes BAR (1985) Early cerebral blood flow and computerized tomography in predicting ischemia after cerebral aneurysm rupture. J Neurosurg 62: 850–855

    PubMed  Google Scholar 

  10. Kuhl DE, Barrio JR, Huang SC, Selin C, Ackermann RF, Lear JL, Wu JL, Lin TH, Phelps ME (1982) Quantifying local cerebral blood flow by N-isoprypyl-p-[123I]iodoamphetamine (IMP) tomography. J Nucl Med 23: 196–203

    PubMed  Google Scholar 

  11. Kuhl DE, Phelps ME, Kowell AP, Metter EJ, Selin C, Winter J (1980) Effects of stroke on local cerebral metabolism and perfusion: mapping by emission computed tomography of18FDG and13NH3. Ann Neurol 8: 47–60

    PubMed  Google Scholar 

  12. Kuroda S, Takigawa S, Kamiyama H, Abe H, Sakuragi M, Motomiya M, Nakagawa T, Mitsumori K, Tsuru M (1990) Diagnosis of hemodynamic compromise in patients with chronic cerebral ischemia; The detection of impaired vasodilatory capacity with133Xe SPECT and acetazolamide (Diamox) test. No Shinkei Geka 18: 167–173

    PubMed  Google Scholar 

  13. Lassen NA (1966) The luxury perfusion syndrome and its possible relation to acute metabolic acidosis localized within the brain. Lancet 2: 1113–1115

    PubMed  Google Scholar 

  14. Lassen NA, Friberg L, Kastrup T, Rizzi D, Jensen JJ (1987) Effects of acetazolamide on cerebral blood flow and brain tissue oxygenation. Postgrad Med J 63: 185–187

    PubMed  Google Scholar 

  15. Lenzi GL, Frackowiak RSJ, Jones T (1982) Cerebral oxygen metabolism and blood flow in human cerebral ischemic infarction. J Cereb Blood Flow Metabol 2: 321–335

    Google Scholar 

  16. Metter EJ, Wasterlain CG, Kuhl DE, Hanson WR, Phelps ME (1981)18FDG positron emission computed tomography in a study of aphasia. Ann Neurol 10: 173–183

    PubMed  Google Scholar 

  17. Meyer CH, Lowe D, Meyer M, Richardson PL, Neil-Dwyer G (1983) Progressive change in cerebral blood flow during the first three weeks after subarachnoid haemorrhage. Neurosurgery 12: 58–76

    PubMed  Google Scholar 

  18. Mickey B, Vorstrup S, Voldby B, Lindewald H, Harmsen A, Lassen NA (1984) Serial measurement of regional cerebral blood flow in patients with SAH using133Xe inhalation and emission computerized tomography. J Neurosurg 60: 916–922

    PubMed  Google Scholar 

  19. Nakagawara J, Wada K, Takeda R, Usami T, Hashimoto I, Shimazaki M, Tanaka C, Nakamura J, Suematsu K (1989) Prediction of cerebral ischemia due to cerebral vasospasm in SAH using SPECT and123I-IMP with acetazolamide test. No Socchu No Geka 17: 301–307

    Google Scholar 

  20. Nishikawa M, Handa H, Hirai O, Kaneko T, Munaka M, Watanabe S, Fukuma A (1989) Pathophysiology and prognosis of patients with ruptured intracranial aneurysm. No Socchu No Geka 17: 95–99

    Google Scholar 

  21. Olsen ST, Lassen NA (1984) A dynamic concept of middle cerebral artery occlusion and cerebral infarction in the acute stage based on interpreting severe hyperemia as a sign of embolic migration. Stroke 15: 458–468

    PubMed  Google Scholar 

  22. Saito I, Ueda Y, Sano K (1977) Significance of vasospasm in the treatment of ruptured intracranial aneurysms. J Neurosurg 47: 412–429

    PubMed  Google Scholar 

  23. Sorteberg W, Lindegaard K-F, Rootwelt K, Dahl A, Nyberg-Hansen R, Russell D, Nornes H (1989) Effect of acetazolamide on cerebral artery blood velocity and regional cerebral blood flow in normal subjects. Acta Neurochir (Wien) 97: 139–145

    Google Scholar 

  24. Sullivan HG, Kingsbury IV TB, Morgan ME, Jeffcoat RD, Allison JD, Goode JJ, McDonnell DE (1987) The rCBF response to Diamox in normal subjects and cerebrovascular disease patients. J Neurosurg 67: 525–534

    PubMed  Google Scholar 

  25. Sunada I (1989) Measurement of cerebral blood flow by single photon emission computed tomography in cases of internal carotid artery occlusion. Neurol Med Chir (Tokyo) 29: 496–502

    Google Scholar 

  26. Ueda T, Kinoshita K, Watanabe K, Hoshi H (1986) Local cerebral blood flow measurement by SPECT using123I-IMP in patients with occlusive cerebrovascular disease. Neurol Med Chir (Tokyo) 26: 601–607

    Google Scholar 

  27. Voldby B, Enevoldsen EM, Jensen JT (1985) Regional CBF, intraventricular pressure, and cerebral metabolism in patients with ruptured intracranial aneurysms. J Neurosurg 62: 48–58

    PubMed  Google Scholar 

  28. Vorstrup S, Brun B, Lassen NA (1986) Evaluation of the cerebral vasodilatory capacity by the acetazolamide test before EC; IC bypass surgery in patients with occlusion of the internal carotid artery. Stroke 17: 1291–1298

    PubMed  Google Scholar 

  29. Wilkinson HA (1989) Cerebral blood flow response to acetazolamide. J Neurosurg 70: 156

    PubMed  Google Scholar 

  30. Winchell HS, Baldwin RM, Lin TH (1980) Development of I-123-labeled amines for brain studies: Localization of I-123 iodophenylalkyl amines in rat brain. J Nucl Med 21: 940–946

    PubMed  Google Scholar 

  31. Winchell HS, Horst WD, Braun L, Oldendorf WH, Hattner R, Parker H (1980) N-isopropyl-[123I]p-iodoamphetamine: Single-pass brain uptake and washout; binding to brain synaptosomes; and localization in dog and monkey brain. J Nucl Med 21: 947–952

    PubMed  Google Scholar 

  32. Yamada T, Shima T, Okada Y, Nishida M, Yamane K, Okita S, Yoshida A (1989) Evaluation of vasospasm using transcranial Doppler sonography and single photon ECT. No Socchu No Geka 17: 308–312

    Google Scholar 

  33. Yamagata S, Kikuchi H, Ihara I, Nagata I, Morooka Y, Naruo Y, Koizumi T, Hashimoto K, Minamikawa J, Miyamoto S (1987) Cerebral blood flow in subarachnoid haemorrhage: Analysis in patients with poor outcome. No Shinkei Geka 15: 1189–1196

    PubMed  Google Scholar 

  34. Yamakami I, Isobe K, Yamaura A, Nakamura T, Makino H (1983) Vasospasm and regional cerebral blood flow (rCBF) in patients with ruptured intracranial aneurysm: Serial rCBF studies with the Xenon-133 inhalation method. Neurosurgery 13: 394–401

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Daiyukai General Hospital, Ichinomiya, Japan

    J. Shinoda, T. Kimura & T. Funakoshi

  2. Department of Neurosurgery, Gifu University School of Medicine, Gifu, Japan

    Y. Araki & Y. Imao

Authors
  1. J. Shinoda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Funakoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Y. Araki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Y. Imao
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shinoda, J., Kimura, T., Funakoshi, T. et al. Acetazolamide reactivity on cerebral blood flow in patients with subarachnoid haemorrhage. Acta neurochir 109, 102–108 (1991). https://doi.org/10.1007/BF01403003

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01403003

Keywords

Search

Navigation