CSF pressure change in cases of non-developing normal pressure hydrocephalus after subarachnoid hemorrhage
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To elucidate the significance of cerebrospinal fluid pressure (CSF pressure) on the development of symptomatic normal pressure hydrocephalus after subarachnoid hemorrhage, continuous monitoring of lumbar CSF pressure was done via the thin polyethylene catheter in 28 cases of subarachnoid hemorrhage with or without symptomatic normal pressure hydrocephalus for 8 to 16 hours including night. The baseline pressure was defined as the mean pressure two hours after catheterization. There were three groups based on the symptomatology; asymptomatic group (A group, 7 cases), group of symptomatic normal pressure hydrocephalus (B group, 16 cases) and group of markedly impaired consciousness (C group, 5 cases).<BR>The baseline pressure was 13.1 ± 5.1 mmHg in A group, 15.9 ± 7.6 mmHg in B group and 20.4 ± 13.7 mmHg in C group. It was higher in B and C groups, though statistical significance was not obtained. There was a general tendency that the pressure wave was more frequent in the higher baseline pressure. B wave was dominant comparing to A wave. In the A group, three of seven cases showed low baseline pressure with no or minimal pressure wave. However, there was two cases which had high baseline pressure of 20 mmHg and four cases of pressure wave; frequent B wave in three and sporadic A wave in one.<BR>In the B group, the pressure wave was noted in all five cases of baseline pressure above 15 mmHg and in six of eleven cases of normal pressure. The higher the baseline pressure, the more the frequency of B wave. There was a tendency of periodic burst of B wave, which was more clearly seen in cases of relatively low baseline pressure. It was noted that there were three cases of low baseline pressure without pressure wave, although clinical symptoms and CT findings were consistent with typical normal pressure hydrocephalus. All of thirteen shunting operations were effective in this B group.<BR>In the C group, the vaseline pressure was varied in each case, pressure wave was noted in cases of high pressure, although A wave noted in one case of low baseline pressure. Shunting operation was effective in three of five case in this C group.<BR>Thus, there are some cases in which correlation of CSF pressure raising and development of symptomatic normal pressure hydrocephalus was not noted, although high baseline pressure and/or frequent B wave were the common finding in them. The importance of brain damage was discussed in conjunction with impaired CSF circulation and CSF pressure.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
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