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Query: UMLS:C0917798 (cerebral ischemia)
 17,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Brain insult in neurosurgical patients is highly dependent on hydroelectrolytic and haemodynamic disturbances. The magnitude of their effect is related to blood-brain barrier integrity and characteristics of cerebral perfusion pressure. Moderate disturbances in ionic balance or CPP may lead to interstitial oedema or worsening of cerebral ischaemia. As a consequence, intracranial pressure (ICP) may rise and neurological status worsen. This study discusses the cerebral effects of intercompartimentary water and electrolyte movements, which themselves are either secondary to early neurological dysfunction, as insipid diabetes, the syndrome of inappropriate ADH secretion, and/or to renal losses of sodium, or iatrogenic, after administration of mannitol or furosemide. Understanding the early mechanism underlying these disorders is essential for treatment. Early interstitial oedema is mainly a consequence of low plasma osmolality, whereas low oncotic pressure plays a minor role. Worsening of cerebral ischemia by hyperglycaemia should contra-indicate glucose for perioperative infusion. Keeping CPP at normal levels is essential, especially in case of disturbances of the autoregulation of the cerebral circulation. Normovolaemia and the choice of an appropriate agent for plasma volume expansion are essential. Correction of hypovolaemia is best obtained with (except for packed red cells when necessary) normal saline, 4% human albumin or hydroxyethylstarch. The benefit of utilizing hypertonic electolytic or HES solutions in neurosurgical patients has still to be assessed.
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PMID:[The injured brain. Basis for hydroelectrolytic and hemodynamic resuscitation]. 809 86

Hyponatremia, natriuresis, and a decrease in plasma volume of greater than 10% occurs in approximately 50% of the patients with aneurysmal SAH, perhaps due to SIADH and CSWS. However, fluid restriction, as indicated in SIADH, might result in vasospasm and cerebral infarction in these patients. Maintaining intravascular volume seems to be important in SAH; several reports suggest that cerebral ischemia can be reversed by use of volume expanders. Fludrocortisone has been shown to reduce natriuresis, which may help maintain plasma volume in patients with SAH. Adequate oral salt intake also appears to have possible therapeutic benefit in these patients. However, it remains unproven whether fludrocortisone results in a decreased incidence of cerebral ischemia. Larger controlled trials are needed to ascertain the impact of fludrocortisone on prevention of cerebral ischemia in patients with SAH.
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PMID:Fludrocortisone in the treatment of subarachnoid hemorrhage-induced hyponatremia. 916 63