积极的脑脊髓液引流可逆转动脉瘤性蛛网膜下腔出血后的迟发性脑缺血：病例报告。
Aggressive CSF diversion reverses delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a case report.
机构信息
Division of Critical Care Neurology, Mayo Clinic, Rochester, MN 55905, USA.
出版信息
Neurocrit Care. 2012 Aug;17(1):112-6. doi: 10.1007/s12028-012-9723-z.
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.
背景
外引流管（EVD）的放置可暂时将脑脊液（CSF）引流，适用于伴有脑积水的动脉瘤性蛛网膜下腔出血（aSAH）患者。
方法
病例报告。
结果
一名 56 岁女性因伴有急性脑积水的 aSAH 被收入我院。放置了 EVD 并将其设置为 15mmHg。将近 72 小时后，她的临床状况恶化。CT 灌注扫描显示双侧分水岭区域低灌注，CT 血管造影显示轻度节段性动脉狭窄。将 EVD 降低至 5mmHg 后，影像学灌注异常和临床症状得到缓解。
结论
我们提出了一种机制，即 CSF 引流可降低 aSAH 后迟发性脑缺血的风险：在较低颅内压（例如 5mmHg）下进行 CSF 引流可以改善微循环中的血流，从而改善组织灌注。
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