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Regional intraparenchymal pressure differences in experimental intracerebral hemorrhage: effect of hypertonic saline.
Crit Care Med 2002; 30(2):435-41CC

Abstract

OBJECTIVE

To study regional intraparenchymal pressures within the cranial cavity during and after formation of intracerebral hemorrhage. We also assessed the effect of hypertonic saline on intraparenchymal pressure in different brain regions and on regional brain distribution of sodium within the brain.

DESIGN

Prospective, controlled, laboratory trial.

SETTINGS

Animal research laboratory.

SUBJECTS

Eight mongrel dogs, weighing 15-25 kg.

INTERVENTION

We introduced an intracerebral hematoma in eight mongrel dogs by infusing 6 mL of autologous arterial blood in the deep white matter adjacent to the basal ganglia. Sodium chloride (23.4%, 1.4 mL/kg) then was administered intravenously 6 hrs after introduction of hematoma.

MEASUREMENTS AND MAIN RESULTS

Parenchymal pressure monitors were placed in the perihematoma region, both frontal lobes, and the cerebellum to record intraparenchymal pressure during and 6 hrs after intracerebral hematoma formation. Intraparenchymal pressure measurements were recorded for 3 more hours after administration of 23.4% sodium chloride. Regional cerebral perfusion pressure was calculated for each intraparenchymal pressure measurement. Regional sodium distribution was measured in extracts from brain regions by using ion selective electrode technique. A higher elevation in intraparenchymal pressure was recorded in the perihematoma region during the introduction of the hematoma compared with other compartments. After 5 mL of autologous blood was introduced, intraparenchymal pressure (mm Hg +/- SE) was significantly higher in the perihematoma region (42.1 +/- 3.5) than in the ipsilateral (30.0 +/- 4.6, p <.05) and contralateral (27.1 +/- 5.5, p <.01) frontal lobes and cerebellum (29.1 +/- 4.5, p <.05). Four hours after introduction of the hematoma, the cerebral perfusion pressure recorded in the perihematoma region (43.6 +/- 9.7) remained significantly lower than in the ipsilateral (58.6 +/- 9.3, p <.05) but not the contralateral frontal lobes (54.7 +/- 10.1) and cerebellum (51.0 +/- 11.1). Administration of 23.4% sodium chloride immediately reduced intraparenchymal pressure in each compartment. This effect was still observed at 3 hrs in each compartment. Sodium concentration was higher in the perihematoma region than in the frontal lobes, cerebellum, or brain stem.

CONCLUSIONS

Prominent differences were observed in intraparenchymal pressure and cerebral perfusion pressure in the perihematoma region and frontal lobes during and after intracerebral hematoma. We speculate that the potential importance of regional intraparenchymal pressure differences in the clinical settings may be under appreciated. In this canine model of intracerebral hematoma, a single dose of hypertonic saline effectively reduces the intraparenchymal pressure in all regions of the brain.

Authors+Show Affiliations

Department of Neurosurgery and the Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 14209-1194, USA. aiqureshi@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11889326

Citation

Qureshi, Adnan I., et al. "Regional Intraparenchymal Pressure Differences in Experimental Intracerebral Hemorrhage: Effect of Hypertonic Saline." Critical Care Medicine, vol. 30, no. 2, 2002, pp. 435-41.
Qureshi AI, Suri MF, Ringer AJ, et al. Regional intraparenchymal pressure differences in experimental intracerebral hemorrhage: effect of hypertonic saline. Crit Care Med. 2002;30(2):435-41.
Qureshi, A. I., Suri, M. F., Ringer, A. J., Guterman, L. R., & Hopkins, L. N. (2002). Regional intraparenchymal pressure differences in experimental intracerebral hemorrhage: effect of hypertonic saline. Critical Care Medicine, 30(2), pp. 435-41.
Qureshi AI, et al. Regional Intraparenchymal Pressure Differences in Experimental Intracerebral Hemorrhage: Effect of Hypertonic Saline. Crit Care Med. 2002;30(2):435-41. PubMed PMID: 11889326.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Regional intraparenchymal pressure differences in experimental intracerebral hemorrhage: effect of hypertonic saline. AU - Qureshi,Adnan I, AU - Suri,M Fareed K, AU - Ringer,Andrew J, AU - Guterman,Lee R, AU - Hopkins,L Nelson, PY - 2002/3/13/pubmed PY - 2002/3/28/medline PY - 2002/3/13/entrez SP - 435 EP - 41 JF - Critical care medicine JO - Crit. Care Med. VL - 30 IS - 2 N2 - OBJECTIVE: To study regional intraparenchymal pressures within the cranial cavity during and after formation of intracerebral hemorrhage. We also assessed the effect of hypertonic saline on intraparenchymal pressure in different brain regions and on regional brain distribution of sodium within the brain. DESIGN: Prospective, controlled, laboratory trial. SETTINGS: Animal research laboratory. SUBJECTS: Eight mongrel dogs, weighing 15-25 kg. INTERVENTION: We introduced an intracerebral hematoma in eight mongrel dogs by infusing 6 mL of autologous arterial blood in the deep white matter adjacent to the basal ganglia. Sodium chloride (23.4%, 1.4 mL/kg) then was administered intravenously 6 hrs after introduction of hematoma. MEASUREMENTS AND MAIN RESULTS: Parenchymal pressure monitors were placed in the perihematoma region, both frontal lobes, and the cerebellum to record intraparenchymal pressure during and 6 hrs after intracerebral hematoma formation. Intraparenchymal pressure measurements were recorded for 3 more hours after administration of 23.4% sodium chloride. Regional cerebral perfusion pressure was calculated for each intraparenchymal pressure measurement. Regional sodium distribution was measured in extracts from brain regions by using ion selective electrode technique. A higher elevation in intraparenchymal pressure was recorded in the perihematoma region during the introduction of the hematoma compared with other compartments. After 5 mL of autologous blood was introduced, intraparenchymal pressure (mm Hg +/- SE) was significantly higher in the perihematoma region (42.1 +/- 3.5) than in the ipsilateral (30.0 +/- 4.6, p <.05) and contralateral (27.1 +/- 5.5, p <.01) frontal lobes and cerebellum (29.1 +/- 4.5, p <.05). Four hours after introduction of the hematoma, the cerebral perfusion pressure recorded in the perihematoma region (43.6 +/- 9.7) remained significantly lower than in the ipsilateral (58.6 +/- 9.3, p <.05) but not the contralateral frontal lobes (54.7 +/- 10.1) and cerebellum (51.0 +/- 11.1). Administration of 23.4% sodium chloride immediately reduced intraparenchymal pressure in each compartment. This effect was still observed at 3 hrs in each compartment. Sodium concentration was higher in the perihematoma region than in the frontal lobes, cerebellum, or brain stem. CONCLUSIONS: Prominent differences were observed in intraparenchymal pressure and cerebral perfusion pressure in the perihematoma region and frontal lobes during and after intracerebral hematoma. We speculate that the potential importance of regional intraparenchymal pressure differences in the clinical settings may be under appreciated. In this canine model of intracerebral hematoma, a single dose of hypertonic saline effectively reduces the intraparenchymal pressure in all regions of the brain. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/11889326/Regional_intraparenchymal_pressure_differences_in_experimental_intracerebral_hemorrhage:_effect_of_hypertonic_saline_ L2 - http://Insights.ovid.com/pubmed?pmid=11889326 DB - PRIME DP - Unbound Medicine ER -