Spinal cord blood flow in patients with acute spinal cord injuries.
Authors of this article are:
Gallagher MJ, Hogg F, Zoumprouli A, Papadopoulos MC, Saadoun S.
A summary of the article is shown below:
The effect of traumatic spinal cord injury on spinal cord blood flow in humans is unknown. Whether intervention to achieve the recommended mean arterial pressure guideline of 85-90 mmHg improves spinal cord blood flow is also unclear. Here, we use laser speckle contrast imaging intraoperatively to visualize blood flow at the injury site in 22 patients with acute, severe spinal cord injuries (American spinal injuries association Impairment Scale, grades A-C). In 17/22 patients, injury site metabolism was also monitored with a microdialysis catheter placed intradurally on the surface of the injured cord. We observed three different spinal cord blood flow patterns, characterized by distinct injury site metabolic signatures, which we term necrosis-penumbra, hyper-perfusion and patchy-perfusion. The necrosis-penumbra pattern, only seen in thoracic injuries, had a core of low blood flow (necrosis) with regions of intermediate blood flow on either side (penumbra). The hyper-perfusion pattern, only seen in cervical injuries, had very high blood flow throughout the injury site. The patchy-perfusion pattern, found in cervical and thoracic injuries, had irregular regions of low, intermediate and high blood flow. Though intervention to increase mean arterial pressure by 20 mmHg increased overall blood flow at the injury site, in 5/22 patients, blood flow increased in some regions but, surprisingly, decreased in other regions. We term this phenomenon blood pressure-induced local steal. In 7/19 patients with mean arterial pressure 85-90 mmHg, parts of the injury site were only perfused in systole, but not in diastole, which we term diastolic ischemia. We conclude that acute, severe traumatic spinal cord injury produces three pathological blood flow patterns at the injury site. Intervention to increase blood pressure may elicit potentially detrimental spinal cord blood flow responses in some patients.
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This article is a good source of information and a good way to become familiar with topics such as:
CLINICAL MANAGEMENT OF CNS INJURY;HUMAN STUDIES;MICRODIALYSIS;SURGERY;spinal cord injury
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