[Hemodilutional therapy in raised intracranial pressure; observations in a case of cerebral infarction associated with polycythemia vera].
A 36-year-old man presented with sudden onset of hemorrhagic cerebral infarction in association with polycythemia vera. On admission this patient manifested semicomatous state and left hemiplegia which were gradually progressed. X ray CT demonstrated a severe hemorrhagic infarction in right MCA territory accompanying marked shift of midline structures. Cerebral angiograms represented occlusion of right MCA showing floating emboli in the internal carotid. Hematocrit value was found to be high as 61.2 per cent. Elevated ICP levels were noted by means of epidural pressure monitoring. Deterioration of patient status was considered to be based on impairment of cerebral circulation due to hemostasis by elevated blood viscosity. In addition to administration of mannitol solution, intermittent exsanguinations, 1000 ml in total amount, were performed and hematocrit levels were corrected by hemodilution. Consciousness level was remarkably improved in accordance with reduction of ICP, which well corresponded to values of hematocrit. Level of ICP and tissue perfusion are convinced to be strongly affected by hemorheological factor in the state of raised ICP.
Inao
S
S
Furuse
M
M
Hotta
T
T
Asai
H
H
Yoshida
K
K
Saso
K
K
Kaneoke
Y
Y
Motegi
Y
Y
D000328:Adult; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D006438:Hemodilution; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D011087:Polycythemia Vera / Q000150:complications* / Q000628:therapy; D014057:Tomography, X-Ray Computed