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CT cerebral blood flow and lambda measurements in adrenoleukodystrophy
ABSTRACTS
444
DOES CONTINUOUS MEASUREMENT OF BRAIN TISSUE TEMPERATURE REFLECT CEREBRAL BLOOD FLOW IN THE SEVERELY I-]OBADINJURED PATIT=2qT?Eion M.R. Oopl~enbetlr Aloir Zaunm', Panos Fatouros, John D. Ward, Ross Bullock. Oiv. of NeurosurgeTy, Medical College o f V ' ~ i a , Richmond, V ' u ' l ~ USA No method is curremly evsilaHc for mea~ring r ~ . t cerel~d Mood flow (d3BF) continuoudy, quantitatively and accurately in the severely ~ ~njured patient. The availebility o f meesufing brain tissue tempenlture (Btemp) lemts to ~oeculation whether or not this p~rsntct=r can be used to detect ~ip~fic.ant reduction in rCBF. We therefore tested the hypothesis that measurementof Btcmp is = v,did indicator ofrCBF Twenty-four severely head h~ured patients (GCS_<8), were studied. A thermo couple, combined in 9 multi-parameter aensor, (Paratrend 7@, Biomedical Sensors, M a l v e ~ PA) was used to ~ r c continuously intre-parenchymal brain tempersture. Data were taken
XENON/CT CEREBRAL BLOOD FLOW AND LAMBDA MEASUREMENTS IN ADRENOLEUKODYSTROPHV. Katsuvuki Obara. Yasuo Fukuuchi, Masahiro Kobari*. Shigeru Watanabe. Tomohisa Dembo. Department of Neurology. School or" Medicine, Keio University. and *Department of Neurology. Tachikawa Hospital, Tokyo, Japan. Objective and Methods: To elucidate the cerebral benlod,.namic~ in leukodystrophy, local cerebral blood flow (CBF) aod local partitiotx coefficient (]ambda) were measured by xenon-enhanced CT in tv,o patients with adrenoteukodystropby. Both padenrs" plasma levels OI very long cbain fatty acids were markedly elevated, supporting the diagnosis of adrcnoleukodystrophy. Results: Case I (a 22-year-old man); CT scan revealed low-density areas in the occipital white matter, adjacent to the lateral ventricles. Local CBF showed decreased values of 35 and l0 ml/100 g/rain in the occipital cortex and white matter, respectively. Local CBF values in the frontal cortex and ~ hitc matter were within normal limits (40 and 14 ml/100 ~tmin. respectively). Local laotbda values showed reduction to 0.4 ht the occipital white matter as compared with those of 1.4 in the t/'ont:d white matter. Case 2 (a 58-year-old man); CT scan revealed Iot~densit3, areas in the frontal white matter. Local CBF sho~ ed decreased values of 30 and 8 ml/I O0 ~min in the frontal cortex attd whhe matter. respectively. Local CBF values in the occipital cortex and ~hhe matter ~,.ere within normal limits (40 and 15 ml/100 ~'min. respectively). Local lambda "~aluos showed reduction to 0.64 in the frontal while matter as compared with those of 1.6 in the occipdul v.hite matter. Conclusion: In adrenoleukodystropl~y patients. CBI values were reduced not only in the involved white matter but also hi the neighboring cortical areas. The decreased lambda values in the diseased white manor may reflect demye[ination becanse xenon --as i~ a hpid soluble tracer.
closet to the CBP studies. Rectal temperature (l~emp) wes m e s . u ~ to calculate the differertce between Btemp and Ktcmp (Atcmp-BtcmpRtemp). In this way, the effect o f induced hypothermie, used u a treatment modality for intraeranial pressure control, could be taken into account. Tomogr~ohlc, r~onal CBF was measured, in a 20 mm dlamet~ zone of tissue around the , ~ r , using the stable xenon tedmique. l~gre~on anaJysis,~ non-paremelnc tests were used for data amAlyds, l~-,Bomd CBF was strongly correlated with Bte.mp (r=0.64, P-O.01) and Atemp (r-O.S0, P-O.O0"/). A highly s~gnificant difference in rCBF was found when patients were divided into I) patients with a positive Atemp (Btemp>Rtemp) a ~ 11) patients with a nesative Atemp (Btemp
CEREBRAL BLOOD FLOW FOLLOWING CARDIAC ARREST AND EFFECT OF HYPOTHERMIA. N Toma. H Yoshida. K Ya~i. ,1 Yokota. Senshu Critical Care Medical Center, Osaka,Japan. Obiectivc.s: I. To investigate CBFchange after resuscitation From cardiac arrest and the effect of hypolhermia on CBF and the prognosis. 2. To investigate the relationship between CBF in acute period and the prognosis. Methods: In 28 comatose patients after resuscitation From cardiac arrest , we measured CBF intermittently following period up to ?days using stable Xe-enhanced CT. Patients were divided into two groups (normotermia group: n=14, hypothermia group: n=13) and Glasgow outcome scale was used to evaluate the prognosis. In hypothermia group, body temperature was maintained at 32-34~ for 3 days. Results: I. The outcome of the two groups was shown in table I. normothermia group, 8 patienls showed hyperemia
2. In
(CBF>45mlllOOglmin)
during the following period without the increase of corresponding CMRO2 (uncoupling). On the other hand, only one patient showed hypercmia in hypothermia group. 3. CBF within 4 hours after resuscitation was measured in 22 patients. There were no significant differences in mean CBF among three groups (GR&MD, SD&VS and BD) at that point (table 2). Conclusions:[. Hypothermia had a Favorable effect on file prognosis. 2. Hypolhermia reduced the occurrence of hyperemia after global cerebral ischemia. 3. It wo.sdifficult to predict the outcome in terms of CBF in acute period. Table I.
Table2. GR&MD 5D&VS
BD
normolhcrmia
O
5
7
hypothermta
3
7
O
GR&MD SD&VS CBF 23.2•
29.5•
BD
I
16.?•
i
(alllOOglmin)
SEQUENTIAL CHANGES IN CEREBRAL BLOOD FLOW IN PATIENTS WITH HYPERTENSIVE INTRACEREBRAL HEMATOMA. K Yoshida, Department of Neurological Surgery, Nihon University School ol Medicine, Tokyo, Japan. Sequential cerebral blood flows (CBF) were investigated in patients with surgically-evacuated hypertensive intracerebral hematoma (ICH). The subjects were 17 patients with subcorlical ICH. CBF was studied by means of stable xenon-enhanced computed tomography (xenon CT) before and after surgery, and during chronic slage. Pre-operative CBF and its response to acetazolamide (AZ) on the hematoma side declined in an accordance with increase of hematoma volume. Decreased CBFareas surrounding the hematoma were seen, but these changes of CBF were limited in all cases. Not only global CBF on the hematoma side but also regional CBF surrounding the hematoma were distinclly improved alter evacuation of the hematoma in all cases. Nevertheless, outcome for the these patients may not depend on the improving the CBF but depend on hematoma volume. The therapeutic modalities and outcome are discussed from the aspect of CBF.
444
DOES CONTINUOUS MEASUREMENT OF BRAIN TISSUE TEMPERATURE REFLECT CEREBRAL BLOOD FLOW IN THE SEVERELY I-]OBADINJURED PATIT=2qT?Eion M.R. Oopl~enbetlr Aloir Zaunm', Panos Fatouros, John D. Ward, Ross Bullock. Oiv. of NeurosurgeTy, Medical College o f V ' ~ i a , Richmond, V ' u ' l ~ USA No method is curremly evsilaHc for mea~ring r ~ . t cerel~d Mood flow (d3BF) continuoudy, quantitatively and accurately in the severely ~ ~njured patient. The availebility o f meesufing brain tissue tempenlture (Btemp) lemts to ~oeculation whether or not this p~rsntct=r can be used to detect ~ip~fic.ant reduction in rCBF. We therefore tested the hypothesis that measurementof Btcmp is = v,did indicator ofrCBF Twenty-four severely head h~ured patients (GCS_<8), were studied. A thermo couple, combined in 9 multi-parameter aensor, (Paratrend 7@, Biomedical Sensors, M a l v e ~ PA) was used to ~ r c continuously intre-parenchymal brain tempersture. Data were taken
XENON/CT CEREBRAL BLOOD FLOW AND LAMBDA MEASUREMENTS IN ADRENOLEUKODYSTROPHV. Katsuvuki Obara. Yasuo Fukuuchi, Masahiro Kobari*. Shigeru Watanabe. Tomohisa Dembo. Department of Neurology. School or" Medicine, Keio University. and *Department of Neurology. Tachikawa Hospital, Tokyo, Japan. Objective and Methods: To elucidate the cerebral benlod,.namic~ in leukodystrophy, local cerebral blood flow (CBF) aod local partitiotx coefficient (]ambda) were measured by xenon-enhanced CT in tv,o patients with adrenoteukodystropby. Both padenrs" plasma levels OI very long cbain fatty acids were markedly elevated, supporting the diagnosis of adrcnoleukodystrophy. Results: Case I (a 22-year-old man); CT scan revealed low-density areas in the occipital white matter, adjacent to the lateral ventricles. Local CBF showed decreased values of 35 and l0 ml/100 g/rain in the occipital cortex and white matter, respectively. Local CBF values in the frontal cortex and ~ hitc matter were within normal limits (40 and 14 ml/100 ~tmin. respectively). Local laotbda values showed reduction to 0.4 ht the occipital white matter as compared with those of 1.4 in the t/'ont:d white matter. Case 2 (a 58-year-old man); CT scan revealed Iot~densit3, areas in the frontal white matter. Local CBF sho~ ed decreased values of 30 and 8 ml/I O0 ~min in the frontal cortex attd whhe matter. respectively. Local CBF values in the occipital cortex and ~hhe matter ~,.ere within normal limits (40 and 15 ml/100 ~'min. respectively). Local lambda "~aluos showed reduction to 0.64 in the frontal while matter as compared with those of 1.6 in the occipdul v.hite matter. Conclusion: In adrenoleukodystropl~y patients. CBI values were reduced not only in the involved white matter but also hi the neighboring cortical areas. The decreased lambda values in the diseased white manor may reflect demye[ination becanse xenon --as i~ a hpid soluble tracer.
closet to the CBP studies. Rectal temperature (l~emp) wes m e s . u ~ to calculate the differertce between Btemp and Ktcmp (Atcmp-BtcmpRtemp). In this way, the effect o f induced hypothermie, used u a treatment modality for intraeranial pressure control, could be taken into account. Tomogr~ohlc, r~onal CBF was measured, in a 20 mm dlamet~ zone of tissue around the , ~ r , using the stable xenon tedmique. l~gre~on anaJysis,~ non-paremelnc tests were used for data amAlyds, l~-,Bomd CBF was strongly correlated with Bte.mp (r=0.64, P-O.01) and Atemp (r-O.S0, P-O.O0"/). A highly s~gnificant difference in rCBF was found when patients were divided into I) patients with a positive Atemp (Btemp>Rtemp) a ~ 11) patients with a nesative Atemp (Btemp
CEREBRAL BLOOD FLOW FOLLOWING CARDIAC ARREST AND EFFECT OF HYPOTHERMIA. N Toma. H Yoshida. K Ya~i. ,1 Yokota. Senshu Critical Care Medical Center, Osaka,Japan. Obiectivc.s: I. To investigate CBFchange after resuscitation From cardiac arrest and the effect of hypolhermia on CBF and the prognosis. 2. To investigate the relationship between CBF in acute period and the prognosis. Methods: In 28 comatose patients after resuscitation From cardiac arrest , we measured CBF intermittently following period up to ?days using stable Xe-enhanced CT. Patients were divided into two groups (normotermia group: n=14, hypothermia group: n=13) and Glasgow outcome scale was used to evaluate the prognosis. In hypothermia group, body temperature was maintained at 32-34~ for 3 days. Results: I. The outcome of the two groups was shown in table I. normothermia group, 8 patienls showed hyperemia
2. In
(CBF>45mlllOOglmin)
during the following period without the increase of corresponding CMRO2 (uncoupling). On the other hand, only one patient showed hypercmia in hypothermia group. 3. CBF within 4 hours after resuscitation was measured in 22 patients. There were no significant differences in mean CBF among three groups (GR&MD, SD&VS and BD) at that point (table 2). Conclusions:[. Hypothermia had a Favorable effect on file prognosis. 2. Hypolhermia reduced the occurrence of hyperemia after global cerebral ischemia. 3. It wo.sdifficult to predict the outcome in terms of CBF in acute period. Table I.
Table2. GR&MD 5D&VS
BD
normolhcrmia
O
5
7
hypothermta
3
7
O
GR&MD SD&VS CBF 23.2•
29.5•
BD
I
16.?•
i
(alllOOglmin)
SEQUENTIAL CHANGES IN CEREBRAL BLOOD FLOW IN PATIENTS WITH HYPERTENSIVE INTRACEREBRAL HEMATOMA. K Yoshida, Department of Neurological Surgery, Nihon University School ol Medicine, Tokyo, Japan. Sequential cerebral blood flows (CBF) were investigated in patients with surgically-evacuated hypertensive intracerebral hematoma (ICH). The subjects were 17 patients with subcorlical ICH. CBF was studied by means of stable xenon-enhanced computed tomography (xenon CT) before and after surgery, and during chronic slage. Pre-operative CBF and its response to acetazolamide (AZ) on the hematoma side declined in an accordance with increase of hematoma volume. Decreased CBFareas surrounding the hematoma were seen, but these changes of CBF were limited in all cases. Not only global CBF on the hematoma side but also regional CBF surrounding the hematoma were distinclly improved alter evacuation of the hematoma in all cases. Nevertheless, outcome for the these patients may not depend on the improving the CBF but depend on hematoma volume. The therapeutic modalities and outcome are discussed from the aspect of CBF.