Postoperative hyperperfusion syndrome in elderly patients with chronic subdural hematoma

Citation
K. Ogasawara et al., Postoperative hyperperfusion syndrome in elderly patients with chronic subdural hematoma, SURG NEUROL, 54(2), 2000, pp. 155-159
Citations number
20
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Neurology
Journal title
SURGICAL NEUROLOGY
ISSN journal
0090-3019 → ACNP
Volume
54
Issue
2
Year of publication
2000
Pages
155 - 159
Database
ISI
SICI code
0090-3019(200008)54:2<155:PHSIEP>2.0.ZU;2-G
Abstract
BACKGROUND Temporary acute agitated delirium is a frequent complication after surgery for chronic subdural hematoma (CSH) in elderly patients. To clarify the pat hogenic mechanism underlying this complication, we measured cerebral blood flow before and after surgery in elderly patients with CSHs. METHODS Twenty-seven patients aged 75 years or older with unilateral CSH underwent treatment involving a single burr hole craniostomy with continuous catheter drainage. Cerebral blood flow was measured using single photon emission co mputed tomography 1 day before surgery, and at 1 hour and 24 hours after su rgery. Acute agitated delirium was diagnosed by the characteristic behavior al abnormality. RESULTS SPECT imaging 1 hour after surgery demonstrated hyperperfusion in the cereb ral cortex beneath the CSH in 14 patients (51.9%). Of these 14 patients, fi ve showed acute agitated delirium a few hours after surgery that persisted for 10 to 12 hours. A hematoma was detected in the right hemisphere in all five patients. Hyperperfusion was significantly more intense in patients wi th acute agitated delirium both 1 hour and 24 hours after surgery than in p atients (n = 9) without acute agitated delirium. Moreover, mean arterial bl ood pressure during the first postoperative hour was significantly higher i n patients with acute agitated delirium. CONCLUSION In elderly patients with CSH, intense and prolonged hyperperfusion after su rgery induces temporary acute agitated delirium. This postoperative hyperpe rfusion syndrome is exacerbated by hypertension. (C) 2000 by Elsevier Scien ce Inc.