Effect of mannitol on the traumatized spinal cord. Microangiography, blood flow patterns, and electrophysiology.

The effects of mannitol on the spinal cord blood flow patterns in experimental traumatic paraplegia were correlated with microangiographic and electrophysiologic studies. At 1 hour following a therapeutic dose of mannitol (3 g/kg), an improved fluorescent intramedullary vascular pattern was detected among the mannitol-treated animals relative to those that were not treated. Within 4 hours, perfusion of many areas of the lateral white matter of the spinal cord often approximated normal in the mannitol-treated group. This pattern of perfusion was in striking contrast to that seen in the spinal cord of untreated animals, which displayed an almost total lack of fluorescing vessels at this later time. These findings correlated with an increased vascular caliber as revealed by microangiography and were postulated to be the result of a decrease in vasospasm and an expanded intramedullary blood volume following the administration of mannitol. Although mannitol therapy did not reverse the loss of the cortical evoked response observed during the 4-hour interval studied, the observation of improved blood flow patterns in the white matter is encouraging and warrants further study.