ABSTRACT
OBJECTIVE: Prolonged improvement in neurological and mental disorders has been seen after only cranioplasty in patients initially treated with external decompression for high intracranial pressure. The objective was to evaluate, using 133Xe CT and 31P magnetic resonance spectroscopy (MRS), how restoring the bone itself can influence cerebral blood flow and cerebral energy metabolism after high intracranial pressure is attenuated. METHODS: Seven patients (45-65 years old) who had undergone external decompression to prevent uncontrollable intracranial hypertension after acute subarachnoid haemorrhage were evaluated. Cerebral blood flow and metabolic changes were evaluated before and after cranioplasty. RESULTS: The ratio of phosphocreatine to inorganic phosphate (PCr/Pi), which is a sensitive index of cerebral energy depletion, was calculated and beta-ATP was measured. The cerebral blood flow value in the thalamus was normalised, from 44 (SD 9) to 56 (SD 8) ml/100 g/min (P < 0.01) and the value in the hemisphere increased from 26 (SD 3) to 29 (SD 4) ml/100 g/min on the side with the bone defect. The PCr/Pi ratio improved greatly from 2.53 (SD 0.45) to 3.01 (SD 0.24) (P < 0.01). On the normal side, the values of cerebral blood flow and PCr/Pi increased significantly (P < 0.01) after cranioplasty, possibly due to transneural suppression. The pH of brain tissue was unchanged bilaterally after cranioplasty. CONCLUSION: Cranioplasty should be carried out as soon as oedema has disappeared, because a bone defect itself may decrease cerebral blood flow and disturb energy metabolism.
Subject(s)
Magnetic Resonance Spectroscopy , Skull/abnormalities , Skull/surgery , Thalamus , Aged , Blood Gas Analysis , Humans , Intracranial Aneurysm/complications , Intracranial Aneurysm/physiopathology , Intracranial Pressure , Male , Middle Aged , Phosphates/analysis , Phosphocreatine/analysis , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/physiopathology , Thalamus/blood supply , Thalamus/metabolism , Thalamus/surgeryABSTRACT
PURPOSE: To determine whether the depression of cerebral bioenergetic metabolism caused by chronic subdural hematomas can account for neurologic dysfunction and whether the degree of metabolic depression may be useful for clinical assessment and therapy. METHODS: Sixteen patients who had chronic subdural hematomas with hemiparesis and/or mental disturbances underwent phosphorous 31 MR spectroscopy before and 10 to 14 days after surgery. Phosphorous 31 MR spectroscopy was also performed on 5 patients who had chronic subdural hematomas with only slight headaches who were treated by conservative therapy and on 10 healthy volunteers. RESULTS: The peroperative phosphocreatine-to-inorganic phosphate ratio (2.10 +/- 0.36) improved to normal values (2.69 +/- 0.44) after evacuation of hematomas. This improvement was accompanied by complete disappearance of hemiparesis and/or mental disturbance. Brain tissue pH also improved from 7.07 +/- 0.11 to 7.205 +/- 0.13 after surgery. On the other hand, patients who had chronic subdural hematomas with only slight headaches had the same phosphocreatine-to-inorganic phosphate ratio and brain intracellular pH as healthy volunteers. CONCLUSION: The phosphocreatine-to-inorganic phosphate ratio may be useful for determining when to operate on patients with chronic subdural hematomas and to assess the efficacy of treatment.
Subject(s)
Energy Metabolism/physiology , Hematoma, Subdural/physiopathology , Magnetic Resonance Spectroscopy/methods , Phosphates/metabolism , Postoperative Complications/physiopathology , Acid-Base Equilibrium/physiology , Adolescent , Adult , Aged , Aged, 80 and over , Brain/physiopathology , Chronic Disease , Female , Hematoma, Subdural/diagnosis , Hematoma, Subdural/surgery , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neurologic Examination , Phosphocreatine/metabolism , Postoperative Complications/diagnosisABSTRACT
A 74-year-old male was admitted to our hospital because of hemoptysis. Bronchoscopic examination showed a polypoid lesion in the right middle lobe bronchus. Biopsy of the polypoid lesion caused a massive bleeding. A massive hemoptysis of about 1,200 ml occurred again on the 13th day after biopsy, angiographic embolization of the right bronchial artery was performed successfully. Dilatation, convolution and hypervascularization of the right bronchial artery were observed, and anastomosis with pulmonary artery was seen. The diagnosis of primary racemose hemangioma of the bronchial artery was made. There was no recurrence of hemoptysis 3 years after the embolization procedure. Bronchial artery embolization is an effective method of treatment of hemoptysis due to racemose hemangioma.
