Multimodal Regional Brain Monitoring of Tissue Ischemia in Severe Cerebral Venous Sinus Thrombosis.
Aged
Anticoagulants
/ therapeutic use
Brain
Brain Ischemia
/ diagnosis
Cerebral Angiography
Computed Tomography Angiography
Endovascular Procedures
Female
Glucose
/ metabolism
Heparin
/ therapeutic use
Humans
Intracranial Pressure
Lactic Acid
/ metabolism
Lateral Sinus Thrombosis
/ complications
Magnetic Resonance Angiography
Male
Microdialysis
/ methods
Middle Aged
Monitoring, Physiologic
/ methods
Oxygen
/ metabolism
Sagittal Sinus Thrombosis
/ complications
Sinus Thrombosis, Intracranial
/ complications
Superior Sagittal Sinus
/ diagnostic imaging
Thrombectomy
/ methods
Tomography, X-Ray Computed
Transverse Sinuses
/ diagnostic imaging
Cerebral venous sinus thrombosis
Endovascular mechanical thrombectomy
Multimodal brain monitoring
Journal
Neurocritical care
ISSN: 1556-0961
Titre abrégé: Neurocrit Care
Pays: United States
ID NLM: 101156086
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
pubmed:
26
2
2019
medline:
9
7
2020
entrez:
27
2
2019
Statut:
ppublish
Résumé
Comatose critically ill patients with severe diffuse cerebral venous thrombosis (CVT) are at high risk of secondary hypoxic/ischemic insults, which may considerably worsen neurological recovery. Multimodal brain monitoring (MBM) may therefore improve patient care in this setting, yet no data are available in the literature. We report two patients with coma following severe diffuse CVT who underwent emergent invasive MBM with intracranial pressure (ICP), brain tissue oximetry (PbtO Despite effective therapeutic UFH (aPTT two times baseline levels in the two subjects), average CMD levels of lactate and glucose in the 6 h prior to EMT displayed evidence of regional brain ischemia. The EMT procedure was associated with a rapid (within 6 h) improvement in both CMD lactate (6.42 ± 0.61 4.89 ± 0.55 mmol/L, p = 0.02) and glucose (0.49 ± 0.17 vs. 0.96 ± 0.32 mmol/L, p = 0.0005). EMT was also associated with a significant increase in PbtO This study illustrates the potential utility of continuous bedside MBM in patients with coma after severe brain injury, irrespective of the primary acute cerebral condition. Despite adequate ICP and PbtO
Sections du résumé
BACKGROUND
Comatose critically ill patients with severe diffuse cerebral venous thrombosis (CVT) are at high risk of secondary hypoxic/ischemic insults, which may considerably worsen neurological recovery. Multimodal brain monitoring (MBM) may therefore improve patient care in this setting, yet no data are available in the literature.
METHODS
We report two patients with coma following severe diffuse CVT who underwent emergent invasive MBM with intracranial pressure (ICP), brain tissue oximetry (PbtO
RESULTS
Despite effective therapeutic UFH (aPTT two times baseline levels in the two subjects), average CMD levels of lactate and glucose in the 6 h prior to EMT displayed evidence of regional brain ischemia. The EMT procedure was associated with a rapid (within 6 h) improvement in both CMD lactate (6.42 ± 0.61 4.89 ± 0.55 mmol/L, p = 0.02) and glucose (0.49 ± 0.17 vs. 0.96 ± 0.32 mmol/L, p = 0.0005). EMT was also associated with a significant increase in PbtO
CONCLUSIONS
This study illustrates the potential utility of continuous bedside MBM in patients with coma after severe brain injury, irrespective of the primary acute cerebral condition. Despite adequate ICP and PbtO
Identifiants
pubmed: 30805844
doi: 10.1007/s12028-019-00695-7
pii: 10.1007/s12028-019-00695-7
doi:
Substances chimiques
Anticoagulants
0
Lactic Acid
33X04XA5AT
Heparin
9005-49-6
Glucose
IY9XDZ35W2
Oxygen
S88TT14065
Types de publication
Case Reports
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
297-303Références
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