Relation between brain displacement and local cerebral blood flow in patients with chronic subdural haematoma.
OBJECTIVE
To evaluate the relation between brain displacement, clinical signs and symptoms, and local cerebral blood flow (lCBF) in patients with chronic subdural haematoma (CSDH).


METHODS
Forty five patients (age range 58-87 years, mean 71.9 (SD 8.4)) with unilateral CSDH were studied. Patients were categorised into three groups: I, headache (n=16); II, paresis (n=14); and III, mental change (n=15). T1 weighted MR images were obtained in all patients preoperatively. Quantitative values of maximum haematoma thickness, midline shift, and brain rotation angle were measured on axial and coronal MR images. In 21 patients, lCBF was measured by Xe enhanced CT. Values for lCBF were obtained in selected regions of interest in the frontal cortex, thalamus, and hemisphere on both the haematoma and contralateral sides.


RESULTS
The lCBF reduction in the ipsilateral frontal cortex showed the best linear correlation with haematoma thickness (r=0.57), whereas the reduction in the ipsilateral thalamus had the most significant correlation with pineal shift (r=0.65) and third ventricle incline (r=0.67). In patients with paresis, lCBF decreased significantly on the ipsilateral side of both the frontal cortex and thalamus (p<0.05), whereas patients with mental change showed a significant reduction of lCBF on both sides of the thalamus (p<0.01) and in the ipsilateral frontal cortex (p<0.01).


CONCLUSIONS
The lCBF reduction and clinical symptoms correlated well with local brain displacement in patients with CSDH. The lCBF in the central cerebral area including the thalamus was reduced in patients with clinical signs. The mental changes found were thought to derive from mild impairment of consciousness due to upper brain stem displacement.
Inao
S
S
Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsarumai Showa, Nagoya 466-8550, Japan. sinao@nagoya-1st.jrc.or.jp
Kawai
T
T
Kabeya
R
R
Sugimoto
T
T
Yamamoto
M
M
Hata
N
N
Isobe
T
T
Yoshida
J
J
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001933:Brain Stem / Q000098:blood supply / Q000503:physiopathology; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000098:blood supply / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D003243:Consciousness; D005625:Frontal Lobe / Q000098:blood supply / Q000503:physiopathology; D006261:Headache / Q000209:etiology; D020200:Hematoma, Subdural, Chronic / Q000145:classification / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards; D001523:Mental Disorders / Q000209:etiology; D008875:Middle Aged; D009431:Neural Conduction; D010291:Paresis / Q000209:etiology; D011930:Reaction Time; D012720:Severity of Illness Index; D013788:Thalamus / Q000098:blood supply / Q000503:physiopathology; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards