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Aggressive CSF Diversion Reverses Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage: A Case Report

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Abstract

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.

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Disclosures

Drs. Fugate, Rabinstein, and Wijdicks have no disclosures. Dr. Lanzino has educational grants from Covidien and Synthes.

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Authors and Affiliations

  1. Division of Critical Care Neurology, Mayo Clinic, Rochester, MN, USA

    Jennifer E. Fugate, Alejandro A. Rabinstein & Eelco F. M. Wijdicks

  2. Department of Neurosurgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Giuseppe Lanzino

Authors
  1. Jennifer E. Fugate
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  2. Alejandro A. Rabinstein
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  3. Eelco F. M. Wijdicks
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  4. Giuseppe Lanzino
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Corresponding author

Correspondence to Giuseppe Lanzino.

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Fugate, J.E., Rabinstein, A.A., Wijdicks, E.F.M. et al. Aggressive CSF Diversion Reverses Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage: A Case Report. Neurocrit Care 17, 112–116 (2012). https://doi.org/10.1007/s12028-012-9723-z

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  • DOI: https://doi.org/10.1007/s12028-012-9723-z

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