[Prognostic value of computerized rheoencephalography in chronic posttraumatic subdural hematoma: a preliminary report].
OBJECTIVE
The results of treatment of chronic subdural hematoma (CSDH) are still regarded as unsatisfactory. Measurements of cerebral hemodynamics are increasingly used to elucidate the pathophysiology of mental disturbances and hemiparesis in CSDH. On the other hand the clinical studies of cerebrovascular autoregulation in this condition are almost nonexistent. This study was therefore conducted to assess the cerebral artery compliance and the status of the autoregulatory reserve in CSDH as well as their effect on the neurological outcome.


METHODS
Ten patients with posttraumatic CSDH were studied. The status of cerebrovascular autoregulation and compliance of arteries were investigated using computerized rheoencephalography (REG). A classification of the pulse waveform (REGpw) has been devised according to the number of inflection points in the ascending branch. The normal cases have corresponded with only one inflection point (category I). The presence of three or more inflection points was thought as characteristic for regressive changes of the arterial wall (category II). The capacity of autoregulatory reserve was estimated by studying the changes in amplitude of REGpw as a response to upper body-down tilting.


RESULTS
In all patients the REG examination revealed a reduction in autoregulatory reserve. In 3 patients with the worst clinical result of treatment bilateral impairment of cerebrovascular autoregulation was found. The reduction in compliance of arteries was revealed in 6 patients.


CONCLUSIONS
Our preliminary results indicate that bilateral impairment of the cerebral blood flow and the decrease in arterial compliance are of prognostic significance in patients with CSDH.
Klinika Neurolotraumatologii, Collegium Medicum, Uniwersytet Jagielloński w Krakowie. krupa@cm-uj.krakow.pl
Mariusz
M
Krupa
Wojciech
W
Traczewski
Marek
M
Moskała
Dorota
D
Szwabowska
Igor
I
Gościński
D001783:Blood Flow Velocity; D002536:Cerebral Arteries / Q000503:physiopathology*; D002540:Cerebral Cortex / Q000098:blood supply / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D006259:Craniocerebral Trauma / Q000150:complications; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D004569:Electroencephalography / Q000379:methods*; D020200:Hematoma, Subdural, Chronic / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D010992:Plethysmography, Impedance; D011044:Poland; D011237:Predictive Value of Tests; D011379:Prognosis