Cerebral haemodynamic assessment in patients with thalamic haemorrhage: a pilot study with continuous compliance monitoring

Abstract

Thalamic brain haemorrhage is a common disabling and potentially fatal condition. However, management is mainly supportive, very rarely do neurosurgeons resort to evacuation of the haematoma. We hypothesised that cerebral haemodynamic abnormalities in the forms of lost pressure autoregulatory response (PAR) and/or impaired cerebral vasoreactivity (CVR) to carbon dioxide may indicate the haematoma should be aspirated to prevent further brain damage. Patients with thalamic haemorrhage were selected on clinical ground for intracranial pressure (ICP) monitoring and intensive care management. Spiegelberg double lumen intraventricular balloon catheter was inserted as any other fluid-filled ICP monitoring technique, on the side of the haematoma. Data of ICP, arterial blood pressure (ABP), cerebral perfusion pressure (CPP) and intracranial compliance were collected on a minute basis. Hourly averages were used for analysis. To assess PAR and CVR, blood flow velocity (BFV) in both middle cerebral arteries were measured continuously by transcranial Doppler (TCD) ultrasonography. Six patients with medium (15-25 ml) to large (>25 ml) haematoma volume were subjected to ultrasoud-guided aspiration. 51 CVR and 53 PAR tests were performed. 80820 sets of data were prospectively collected. Progressive reduction in ICP and sustained improvement in compliance and BFV were observed after aspiration. Impairment in PAR and/or CVR was consistent with clinical deterioration in four patients. Such disturbance was normalised after aspiration. Increments in BFV and improvement in compliance were demonstrated. Cerebral haemodynamic abnormalities in thalamic haematomas can be demonstrated by the non-invasive TCD ultrasonograpy. These abnormalities can be corrected by aspiration of the haematoma, and hence improve intracranial compliance.