The purpose of this study is to clarify the effectiveness and the indications of the dopamine induced hypertension therapy(IHT) in the treatment of symptomatic cerebral ischemia secondary to aneurysm surgery. Eight patients suffering from ischemic complication of postoperative vasospasm were treated with dopamine induced hypertension therapy and intravascular volume expansion. All of patients underwent CT scan in order to ascertain if their neurological deteriorations were due to vasospasm. The criteria of the indication of IHT are as follows : 1) ischemic symptoms were progressively advanced, 2) there is no hematoma or infarction on CT scan, 3) there is no responses to ischemic symptoms with hyperventilation, intravascular volume expansion, 4) there is no hypovolemia. The blood pressure was raised to 30% above the mean arterial pressure that required for reversal of the ischemic deficit with dopamine induced hypertension and increasing the intravascular volume. In seven of eight patient, a marked improvement in ischemic symptoms occurred after raising blood pressure, and blood volume. In 4 cases, the level of consciousness and neurological deficits were improved within 12 hours after IHT started. IHT is expected to restore the brain tissue from ischemia by increasing blood flow through the arteries of vasospasm and collateral circulation.
Aneurysm* ; Arterial Pressure ; Arteries ; Blood Pressure ; Blood Volume ; Brain ; Brain Ischemia* ; Collateral Circulation ; Consciousness ; Dopamine ; Hematoma ; Humans ; Hypertension* ; Hyperventilation ; Hypovolemia ; Infarction ; Intracranial Aneurysm ; Ischemia ; Tomography, X-Ray Computed ; Vasospasm, Intracranial

The purpose of this study is to clarify the effectiveness and the indications of the dopamine induced hypertension therapy(IHT) in the treatment of symptomatic cerebral ischemia secondary to aneurysm surgery. Eight patients suffering from ischemic complication of postoperative vasospasm were treated with dopamine induced hypertension therapy and intravascular volume expansion. All of patients underwent CT scan in order to ascertain if their neurological deteriorations were due to vasospasm. The criteria of the indication of IHT are as follows : 1) ischemic symptoms were progressively advanced, 2) there is no hematoma or infarction on CT scan, 3) there is no responses to ischemic symptoms with hyperventilation, intravascular volume expansion, 4) there is no hypovolemia. The blood pressure was raised to 30% above the mean arterial pressure that required for reversal of the ischemic deficit with dopamine induced hypertension and increasing the intravascular volume. In seven of eight patient, a marked improvement in ischemic symptoms occurred after raising blood pressure, and blood volume. In 4 cases, the level of consciousness and neurological deficits were improved within 12 hours after IHT started. IHT is expected to restore the brain tissue from ischemia by increasing blood flow through the arteries of vasospasm and collateral circulation.
Aneurysm* ; Arterial Pressure ; Arteries ; Blood Pressure ; Blood Volume ; Brain ; Brain Ischemia* ; Collateral Circulation ; Consciousness ; Dopamine ; Hematoma ; Humans ; Hypertension* ; Hyperventilation ; Hypovolemia ; Infarction ; Intracranial Aneurysm ; Ischemia ; Tomography, X-Ray Computed ; Vasospasm, Intracranial

Two cases of subdural tension pneumocephalus were introduced after posterior fossa surgery in the sitting position. The possible mechanism for entry of air into the subdural space is explained as the fluid pours out air bubbles to the top of the container. All of two cases manifested generalized seizure at recovery room and were diagnosed with plain skull series and computed tomogram. Subdural air evacuated patient fail to recover as expected, following posterior fossa surgery in sitting position.
Humans ; Pneumocephalus* ; Recovery Room ; Seizures ; Skull ; Subdural Space