By Georg E. Cold
During the decade a mess of reviews about the dynamic adjustments in cerebral blood move (CBF), cerebral metabolic cost of oxygen (CMRO2), and intracranial strain (ICP) within the acute section after head harm were released. those reviews were supplemented with stories of cerebral autoregulation, CO2 reactivity and barbiturate reactivity. different investigations contain experiences of cerebrospinal fluid pH, bicarbonate, lactate and pyruvate. during this ebook experimental and scientific experiences of the dynamic adjustments in CBF, CMRO2, CO2 reactivity and barbiturate reactivity are reviewed. The author's personal medical experiences of the dynamic alterations in CBF and cerebral metabolism are summarized and mentioned, and the therapeutical implication as regards using synthetic hyperventilation, sedation with barbiturate and mannitol remedy are discussed.
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Extra resources for Cerebral Blood Flow in Acute Head Injury: The Regulation of Cerebral Blood Flow and Metabolism During the Acute Phase of Head Injury, and Its Significance for Therapy
01 1 2 345 6 7 8 9 10 Patient Fig. 9. The regional CO 2 reactivities measured as the proportion between delta In rCBFjdelta PaC0 2 mm Hg in 10 patients. rCBF was measured as stocastic flow (height over area). Open triangles: Tissue peak regions. Solid squares: Regions without tissue peaks (Acta Anaesthesio! Scand 1977: 21: 359-367. with permission) and 15 after hyperventilation. The frequency of oligaemic rCBF was correlated to the outcome of the patients. In Table 3 the mean value and SD are indicated for PaC0 2 , ICP, and CPP in patients in group I and II.
1989). Creatine-kinase-BB isoenzyme activity has been shown to rise very rapidly in CSF after parenchymal brain damage (Maas 1977, Rabow and Hedman 1979, Bakay and Ward 1983). The increase may be due to destruction of cell membranes, with release of the enzyme into the extracellular space and seepage into the CSF. Clinical studies have shown that creatine kinase isoenzyme activity in CSF is of prognostic significance (Kaste etal. 1981, Nordby and Urdall982, Rabow and Hedman 1985); however, recent studies by Rabow et al.
In the other three patients (ages 25, 26 and 67 years) brainstem lesion was present throughout the studies. A normal or low-flow state persisted in two of these patients, who both died. In one patient, who recovered (group I), bilateral studies were performed three times during the first 48 hours. In both hemispheres maximal flow was recorded within the first 24 hours (Fig. 4, upper part). Studies of CMR0 2 (Study III) 29 CBFinit. f. 6 '1). · -. _. ". 25 In patients with space-occupying lesions (contusion, subdural haematoma, oedema) hemispheric CBF generally was highest ipse1ateral to the lesion (study IX).