Impaired cerebral circulation and the effect of glycerol infusion in the acute stage of hypertensive intracerebral hematoma

The purpose of the present study was to clarify the mechanism of reduction in cerebral blood flow (CBF) in the acute stage of hypertensive intracerebral hematoma and the effect of glycerol infusion on the reduced CBF. We examined 55 cases. Thirty-eight cases showed putaminal hematoma and 17 presented thalamic hematoma. The range of consciousness was from alert to stupor. CBF was measured by single photon emission CT with Xe-133 inhalation within five days after the onset of the hemorrhage. A CBF map was obtained at a slice 5 cm above the OM-line and mean CBF of the affected and non-affected hemispheres was calculated. In 20 of 55 cases, 500 ml of glycerol was intravenously infused for 60 minutes and thereafter CBF was measured again. Epidural pressure was also recorded at the affected frontal area during glycerol infusion in three of the 20 cases. CBF reduced more profoundly in the area around the hematoma on the CBF map. Mean CBF of the affected hemisphere was negatively correlated with the volume of hematoma by a quadratic regression. After glycerol infusion, 13 of 20 cases showed a significant increase in mean CBF of the affected hemisphere, while the other seven cases showed no increase. Mean CBF increased with a higher percentage in cases with ventricular hemorrhage than without ventricular hemorrhage. In three cases where epidural pressure was measured during glycerol infusion, mean CBF increased and epidural pressure decreased. The increase in mean CBF was proportional to a rise in perfusion pressure calculated as pressure difference between mean systemic arterial pressure and mean epidural pressure, indicating impaired autoregulation in these cases.(ABSTRACT TRUNCATED AT 250 WORDS)