The correlation between the preoperative measurement of estimated cerebral perfusion pressure and estimated intracranial pressure as obtained by trans cranial doppler with modified fisher grade as seen in computed tomography scan head in patients with acute sub arachnoid hemorrahage undergoing surgical clipping
DOI:
https://doi.org/10.18203/2349-3933.ijam20195655Keywords:
Estimated cerebral perfusion pressure, Estimated intracerebral pressure, Modified fisher scale, Trans cranial dopplerAbstract
Background: In Aneurysmal Sub Arachnoid haemorrhage, precise Cerebral Perfusion Pressure (CPP) and Intracranial Pressure (ICP) measurement can only be achieved by an invasive monitoring device. The study aimed at non-invasively estimating the preoperative values of CPP and ICP by use of validated formulae. These estimated flow velocities (estimated CPP or eCPP and estimated ICP or eICP) of the Middle Cerebral Artery were obtained by Trans Cranial Doppler ultrasound and comparing it with the preoperative CT Head Fisher Scale. In the Institute Rimed Digi-Lite Trans Cranial Doppler machine was used for research and Siemens (Somatom) 64 CT Scanner from GE (Signa) was used to perform CT scan of patients.
Methods: It is a prospective, observational study which was studied between July 2017 and December 2018 in Post Graduate Institute of Medical Education and Research, Chandigarh, India. This study is a secondary analysis of a prospective observational study which was primarily designed to evaluate the neurological outcome related to the effect of estimated Intracranial Pressure and estimated Cerebral Perfusion Pressure as measured by Trans Cranial Doppler in patients with a SAH. A total of 100 patients were recruited in this study.
Results: There was significant correlation between estimated CPP and Fisher Grading. There was no strong correlation between the modified Fisher Grade and estimated ICP.
Conclusions: This study was able to give a statistically significant correlation between eCPP and Fisher Grading (p value- 0.047), as the Modified Fisher grading increased, so did the eCPP, this observation was unique, and it went against the hypothesis. However, no statistically significant co-relation was seen during comparison of eICP and Fisher Grading (p value- 0.069).
References
Connolly Jr ES, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012 Jun;43(6):1711-37.
Aaslid R, Lundar T, Lindegaard K. Estimation of cerebral perfusion pressure from arterial blood pressure and transcranial Doppler recordings. In: Miller JD, Teasdale GM, Rowan JO, eds. Intracranial pressure. 6th ed. Berlin: Spinger Verlag; 1996:229-231.
Guillaume J, Janny P. Continuous intracranial manometry; importance of the method and first results. Revue Neurol. 1951 Feb;84(2):131.
Czosnyka M, Matta BF, Smielewski P, Kirkpatrick PJ, Pickard JD. Cerebral perfusion pressure in head-injured patients: a noninvasive assessment using transcranial Doppler ultrasonography. J Neurosurg. 1998 May 1;88(5):802-8.
Homburg AM, Jakobsen M, Enevoldsen E. Transcranial Doppler recordings in raised intracranial pressure. Acta Neurolo Scandinavica. 1993 Jun;87(6):488-93.
Moreno JA, Mesalles E, Gener J, Tomasa A, Ley A, Roca J, et al. Evaluating the outcome of severe head injury with transcranial Doppler Ultrasonography. Neurosurg Focus. 2000 Jan 1;8(1):1-7.
Germans MR, Coert BA, Vandertop WP, Verbaan D. Time intervals from subarachnoid hemorrhage to rebleed. J Neurol. 2014 Jul 1;261(7):1425-31.
Wang X, Chen JX, Mao Q, Liu YH, You C. Relationship between intracranial pressure and aneurysmal subarachnoid hemorrhage grades. J Neurol Sci. 2014 Nov 15;346(1-2):284-7.
Lindvall P, Runnerstam M, Birgander R, Koskinen LO. The Fisher grading correlated to outcome in patients with subarachnoid haemorrhage. Brit J Neurosurg. 2009 Jan 1;23(2):188-92.
Carter BG, Butt W, Taylor A. ICP and CPP: excellent predictors of long-term outcome in severely brain injured children. Child's Nervous Sys. 2008 Feb 1;24(2):245-51.
