Hemispheric strokes: clinical or surgical management? Intracranial pressure monitoring of a case and review of the literature

Carvalho, Gustavo Adolpho; Carvalho Filho, Adolpho

doi:10.1590/S0004-282X1995000500020

Abstracts

The authors report a case of a right hemispheric ischemic infarction on a 77-year-old patient that was monitored with an extradural intracranial pressure monitor (Ladd device).We show the huge intracranial hypertension that the brain was submitted despite of the medical treatment. The treatment of hemispheric strokes can be very challenging. The usual antiedema drugs very often prove to be of no help against the mass effect and the high intracranial pressure that some patients present. More recently reports on the literature are showing good results following a decompressive surgery on such ischemic infarcts.

intracranial pressure; monitoring; hemispheric stroke; hemicraniectomy

Os autores apresentam um caso clínico de infarto hemisférico em paciente de 77 anos, no qual a pressão intracraniana foi monitorizada. Apesar do tratamento clínico realizado, a pressão intracraniana se manteve elevada. O tratamento clínico nessa entidade infelizmente mostra, na maioria dos casos, resultados insatisfatórios. Recentemente, novos estudos publicados na literatura mostram resultados promissores obtidos através da craniotomia descompressiva.

monitorização da pressão intracraniana; acidente cerebrovascular hemisférico; hemicraniectomia

Hemispheric strokes. Clinical or surgical management? Intracranial pressure monitoring of a case and review of the literature

Acidentes cerebrovasculares hemisféricos: conduta clínica ou cirúrgica? Monitorização da pressão intracraniana em um caso e revisão da literatura

Gustavo Adolpho Carvalho^I; Adolpho Carvalho Filho^II

^INeurochirurguische Klinikc, Krankenhaus Nordstadt, Deutschland

^IINeurosurgical Department, Clinica Bambina, Rio de Janeiro, Brazil

SUMMARY

The authors report a case of a right hemispheric ischemic infarction on a 77-year-old patient that was monitored with an extradural intracranial pressure monitor (Ladd device).We show the huge intracranial hypertension that the brain was submitted despite of the medical treatment.

The treatment of hemispheric strokes can be very challenging. The usual antiedema drugs very often prove to be of no help against the mass effect and the high intracranial pressure that some patients present. More recently reports on the literature are showing good results following a decompressive surgery on such ischemic infarcts.

Key words:intracranial pressure, monitoring, hemispheric stroke, hemicraniectomy

RESUMO

Os autores apresentam um caso clínico de infarto hemisférico em paciente de 77 anos, no qual a pressão intracraniana foi monitorizada. Apesar do tratamento clínico realizado, a pressão intracraniana se manteve elevada. O tratamento clínico nessa entidade infelizmente mostra, na maioria dos casos, resultados insatisfatórios. Recentemente, novos estudos publicados na literatura mostram resultados promissores obtidos através da craniotomia descompressiva.

Palavras-chave: monitorização da pressão intracraniana, acidente cerebrovascular hemisférico, hemicraniectomia.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 2-maio-1995.

Dr. Gustavo Adolpho Carvalho - Neurochirurgische Klinik, Krankenhaus Nordstadt - Haltenhoffstrasse 41 -30167 Hannover 1 - Deutschland. Fax (49.511) 970 1606.

Dr. Adolpho Carvalho Filho - Clínica Bambina 56/cobertura - 22251-050 Rio de Janeiro RJ - Brasil. Fax: (55.21) 266 6485.

1. Cooper PR, Hagler H, Clark WK, Barnett P. Enhancement of experimental cerebral edema after decompressive craniectomy: implications for the management of severe head injuries. Neurosurgery 1979, 4:296-300.
2. Cushing H. The establishment of cerebral hernia as a decompressive measure of inaccessible brain tumors; with the description of intramuscular methods of making the bone defect in temporal and occiptal regions. Surg Gynecol Obstet 1905, 1:297-314.
3. Delashaw JB, Broaddus WC, Kassel NF, Harley EC, Pendleton GA, Vollmer DG, Maggio WW, Grady MS Treatment of right hemispheric cerebral infartion by hemicraniectomy. Stroke 1990, 21:874-881.
4. Feigin I, Popoff N. Neuropathological observations on cerebral edema. Arch Neurol 1962, 6:151-160.
5. Hatashita S, Hoff JT. The effect of craniectomy on the biomechanics of normal brain. J Neurosurg 1987, 67:573-578.
6. Italian Acute Stroke Study Group. Haemodilution in acute stroke: results of the Italian Haemodilution Trial. Lancet 1988, 13:318-320.
7. Ivamoto HS, Numoto M, Donaghy RMP. Surgical decompression for cerebral and cerebellar infarcts. Stroke 1974, 5:365-370.
8. Kondziolka D, Fazl M. Functional recovery after decompressive craniectomy. Neurosurgery 1988, 23:143-147.
9. Leonhardt G, Weiller C, Müllges W, Korbmacher G, Ringelstein EB. Antikoagulation beim akuten Schalaganfall.Nervenarzt 1991, 62:470-476.
10. Martinez-Vila E, Guillen F, Villanueva JA, Matias-Guiu J, Bigorra J, Gil P, Carbonell A, Martinez-Lage JM. Placebo controlled trial of nimodipine in the treatment of acute ischaemic cerebral infarction. Stroke 1990, 21:1023-1028.
11. Martins LF, Costa V, Costa J, Melo-Souza SE. Temporal lobectomy in ischemic infarction with mass effect. Arq Neuropsiquiatr 1993, 51:118-124.
12. Mathew NT, Rivera VM, Meyer JS, Charney JZ. Double-blind evaluation of glicerol therapy in acute cerebral infarction. Lancet 1972, 2:1327-1329.
13. Moody RA, Ruamsuke S, Mullan SF. An evaluation of decompressive in experimental head injuries. J Neurosurg 1968, 29:586-590.
14. Mulley G, Wilcox RG, Mitchell JRA. Dexametasone in acute stroke. Br Med J 1978, 2:994-996.
15. Norris JW. Comment on study design of stroke treatments. Stroke 1982, 13:527-528.
16. Nussbaum ES, Wolf AL, Sebring L, Mirvis S. Complete temporal lobectomy for surgical resuscitation of patients with transtentorial herniation secondary to unilateral hemispheric swelling. Neurosurgery 1991, 29:62-66.
17. Rengachary SS, Batnitzky S, Morantz RA, Arjunan K, Jeffries B. Hemicraniectomy for acute massive cerebral infarction. Neurosurgery 1981, 8:321-328.
18. Ropper AH, Shafran B. Brain edema after stroke: clinical syndrome and intracranial pressure. Arch Neurol 1984, 41:26-29.
19. Sarabia R, Lobato RD, Rivas JJ: Cerebral hemispheric swelling in severe head injury patients. Acta Neurochir(Wien)(Suppl) 1988, 42:40-46
20. Siesjö BK. Pathophysiology and treatment of focal cerebral ischemia: Part I. Pathophysiology. J Neurosurg 1992, 77:169-184
21. Siesjö BK. Pathophysiology and treatment of focal cerebral ischemia: Part II. Mechanisms of damage and treatment. J Neurosurg 1992, 77:337-354
22. Spence JD, Donner A. Problems in design of stroke treatment trials. Stroke 1982, 13:94-99.
23. Steiger HJ. Outcome of acute supratentorial cerebral infarction in patients under 60. Acta Neurochir(Wien) 1991,111:73-79.
24. Trust Study Group. Randomized, double-bind, placebo-controlled trial of nimodipine in acute stroke. Lancet 1990,336:1205-1209.
25. Venes JL, Collins WF. Bifrontal decompressive craniectomy in the management of head trauma. J Neurosurg 1975. 42:49-53.
26. Young PH, Smith KR, Dunn RC. Surgical decompression after cerebral hemispheric stroke. South Med J 1982, 75:473-474.

Publication Dates

Publication in this collection
08 Dec 2010
Date of issue
Dec 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Cooper PR, Hagler H, Clark WK, Barnett P. Enhancement of experimental cerebral edema after decompressive craniectomy: implications for the management of severe head injuries. Neurosurgery 1979, 4:296-300.

[2] 2. Cushing H. The establishment of cerebral hernia as a decompressive measure of inaccessible brain tumors; with the description of intramuscular methods of making the bone defect in temporal and occiptal regions. Surg Gynecol Obstet 1905, 1:297-314.

[3] 3. Delashaw JB, Broaddus WC, Kassel NF, Harley EC, Pendleton GA, Vollmer DG, Maggio WW, Grady MS Treatment of right hemispheric cerebral infartion by hemicraniectomy. Stroke 1990, 21:874-881.

[4] 4. Feigin I, Popoff N. Neuropathological observations on cerebral edema. Arch Neurol 1962, 6:151-160.

[5] 5. Hatashita S, Hoff JT. The effect of craniectomy on the biomechanics of normal brain. J Neurosurg 1987, 67:573-578.

[6] 6. Italian Acute Stroke Study Group. Haemodilution in acute stroke: results of the Italian Haemodilution Trial. Lancet 1988, 13:318-320.

[7] 7. Ivamoto HS, Numoto M, Donaghy RMP. Surgical decompression for cerebral and cerebellar infarcts. Stroke 1974, 5:365-370.

[8] 8. Kondziolka D, Fazl M. Functional recovery after decompressive craniectomy. Neurosurgery 1988, 23:143-147.

[9] 9. Leonhardt G, Weiller C, Müllges W, Korbmacher G, Ringelstein EB. Antikoagulation beim akuten Schalaganfall.Nervenarzt 1991, 62:470-476.

[10] 10. Martinez-Vila E, Guillen F, Villanueva JA, Matias-Guiu J, Bigorra J, Gil P, Carbonell A, Martinez-Lage JM. Placebo controlled trial of nimodipine in the treatment of acute ischaemic cerebral infarction. Stroke 1990, 21:1023-1028.

[11] 11. Martins LF, Costa V, Costa J, Melo-Souza SE. Temporal lobectomy in ischemic infarction with mass effect. Arq Neuropsiquiatr 1993, 51:118-124.

[12] 12. Mathew NT, Rivera VM, Meyer JS, Charney JZ. Double-blind evaluation of glicerol therapy in acute cerebral infarction. Lancet 1972, 2:1327-1329.

[13] 13. Moody RA, Ruamsuke S, Mullan SF. An evaluation of decompressive in experimental head injuries. J Neurosurg 1968, 29:586-590.

[14] 14. Mulley G, Wilcox RG, Mitchell JRA. Dexametasone in acute stroke. Br Med J 1978, 2:994-996.

[15] 15. Norris JW. Comment on study design of stroke treatments. Stroke 1982, 13:527-528.

[16] 16. Nussbaum ES, Wolf AL, Sebring L, Mirvis S. Complete temporal lobectomy for surgical resuscitation of patients with transtentorial herniation secondary to unilateral hemispheric swelling. Neurosurgery 1991, 29:62-66.

[17] 17. Rengachary SS, Batnitzky S, Morantz RA, Arjunan K, Jeffries B. Hemicraniectomy for acute massive cerebral infarction. Neurosurgery 1981, 8:321-328.

[18] 18. Ropper AH, Shafran B. Brain edema after stroke: clinical syndrome and intracranial pressure. Arch Neurol 1984, 41:26-29.

[19] 19. Sarabia R, Lobato RD, Rivas JJ: Cerebral hemispheric swelling in severe head injury patients. Acta Neurochir(Wien)(Suppl) 1988, 42:40-46

[20] 20. Siesjö BK. Pathophysiology and treatment of focal cerebral ischemia: Part I. Pathophysiology. J Neurosurg 1992, 77:169-184

[21] 21. Siesjö BK. Pathophysiology and treatment of focal cerebral ischemia: Part II. Mechanisms of damage and treatment. J Neurosurg 1992, 77:337-354

[22] 22. Spence JD, Donner A. Problems in design of stroke treatment trials. Stroke 1982, 13:94-99.

[23] 23. Steiger HJ. Outcome of acute supratentorial cerebral infarction in patients under 60. Acta Neurochir(Wien) 1991,111:73-79.

[24] 24. Trust Study Group. Randomized, double-bind, placebo-controlled trial of nimodipine in acute stroke. Lancet 1990,336:1205-1209.

[25] 25. Venes JL, Collins WF. Bifrontal decompressive craniectomy in the management of head trauma. J Neurosurg 1975. 42:49-53.

[26] 26. Young PH, Smith KR, Dunn RC. Surgical decompression after cerebral hemispheric stroke. South Med J 1982, 75:473-474.