Central herniation revealed by focal decrease in blood flow without elevation of intracranial pressure: a case report.

Abstract:

:Until recently, in standard hospital settings the tissue blood supply could be inferred only from indirect measures such as assessment of the clinical signs and intracranial pressure (ICP) monitoring. This critical parameter can now be imaged directly with stable xenon-enhanced computed tomographic (CT) imaging. The procedure requires only an additional 10 minutes after a standard head study, yet it provides potentially vital information about tissue perfusion. We describe here a patient in whom a frontal lobe hematoma produced a direct mass effect, causing an element of central herniation with relative sparing of lateral and posterior cortical regions. Although the ICP recordings remained unchanged, symptoms of brain stem compression became apparent. Xenon/CT cerebral blood flow (CBF) mapping demonstrated a flow decrease mainly within the left frontal lobe and throughout central ganglionic structures. After removal of the left frontal hematoma, both clinical status and local and central flow improved. Because the xenon/CT method combines direct anatomical information with blood flow information in one examination, it may be a valuable clinical tool in providing a better understanding of pathophysiology in patients with head injuries and other mass lesions.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Wozney P,Yonas H,Latchaw RE,Gur D,Good W

doi

10.1227/00006123-198510000-00018

subject

Has Abstract

pub_date

1985-10-01 00:00:00

pages

641-4

issue

4

eissn

0148-396X

issn

1524-4040

journal_volume

17

pub_type

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