Regional intraparenchymal pressure differences in experimental intracerebral hemorrhage: effect of hypertonic saline.
OBJECTIVE
To study regional intraparenchymal pressures within the cranial cavity during and after formation of intracerebral hemorrhage. We also assessed the effect of hypertonic saline on intraparenchymal pressure in different brain regions and on regional brain distribution of sodium within the brain.


METHODS
Prospective, controlled, laboratory trial.


METHODS
Animal research laboratory.


METHODS
Eight mongrel dogs, weighing 15-25 kg.


METHODS
We introduced an intracerebral hematoma in eight mongrel dogs by infusing 6 mL of autologous arterial blood in the deep white matter adjacent to the basal ganglia. Sodium chloride (23.4%, 1.4 mL/kg) then was administered intravenously 6 hrs after introduction of hematoma.


RESULTS
Parenchymal pressure monitors were placed in the perihematoma region, both frontal lobes, and the cerebellum to record intraparenchymal pressure during and 6 hrs after intracerebral hematoma formation. Intraparenchymal pressure measurements were recorded for 3 more hours after administration of 23.4% sodium chloride. Regional cerebral perfusion pressure was calculated for each intraparenchymal pressure measurement. Regional sodium distribution was measured in extracts from brain regions by using ion selective electrode technique. A higher elevation in intraparenchymal pressure was recorded in the perihematoma region during the introduction of the hematoma compared with other compartments. After 5 mL of autologous blood was introduced, intraparenchymal pressure (mm Hg +/- SE) was significantly higher in the perihematoma region (42.1 +/- 3.5) than in the ipsilateral (30.0 +/- 4.6, p <.05) and contralateral (27.1 +/- 5.5, p <.01) frontal lobes and cerebellum (29.1 +/- 4.5, p <.05). Four hours after introduction of the hematoma, the cerebral perfusion pressure recorded in the perihematoma region (43.6 +/- 9.7) remained significantly lower than in the ipsilateral (58.6 +/- 9.3, p <.05) but not the contralateral frontal lobes (54.7 +/- 10.1) and cerebellum (51.0 +/- 11.1). Administration of 23.4% sodium chloride immediately reduced intraparenchymal pressure in each compartment. This effect was still observed at 3 hrs in each compartment. Sodium concentration was higher in the perihematoma region than in the frontal lobes, cerebellum, or brain stem.


CONCLUSIONS
Prominent differences were observed in intraparenchymal pressure and cerebral perfusion pressure in the perihematoma region and frontal lobes during and after intracerebral hematoma. We speculate that the potential importance of regional intraparenchymal pressure differences in the clinical settings may be under appreciated. In this canine model of intracerebral hematoma, a single dose of hypertonic saline effectively reduces the intraparenchymal pressure in all regions of the brain.
Qureshi
Adnan I
AI
Department of Neurosurgery and the Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 14209-1194, USA. aiqureshi@hotmail.com
Suri
M Fareed K
MF
Ringer
Andrew J
AJ
Guterman
Lee R
LR
Hopkins
L Nelson
LN
D000704:Analysis of Variance; D000818:Animals; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000503:physiopathology; D004195:Disease Models, Animal; D004285:Dogs; D005260:Female; D019586:Intracranial Hypertension / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D008297:Male; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D013997:Time Factors
D012462:Saline Solution, Hypertonic