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Neurocritical Care
Published in: Neurocritical Care 1/2012

01-08-2012 | Practical Pearl

Aggressive CSF Diversion Reverses Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage: A Case Report

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

Published in: Neurocritical Care | Issue 1/2012

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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.
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Metadata
Title
Aggressive CSF Diversion Reverses Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage: A Case Report
Authors
Jennifer E. Fugate
Alejandro A. Rabinstein
Eelco F. M. Wijdicks
Giuseppe Lanzino
Publication date
01-08-2012
Publisher
Humana Press Inc
Published in
Neurocritical Care / Issue 1/2012
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-012-9723-z

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