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Central herniation revealed by focal decrease in blood flow without elevation of intracranial pressure: a case

P Wozney, H Yonas, R E Latchaw

    Neurosurgery
    |October 1, 1985
    PubMed
    Summary
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    Stable xenon-enhanced computed tomographic (CT) imaging now directly measures tissue blood supply. This technique revealed decreased cerebral blood flow (CBF) in a patient with a frontal lobe hematoma, improving after surgical removal.

    Area of Science:

    • Neurology
    • Radiology
    • Medical Imaging

    Background:

    • Assessing tissue blood supply in hospitals traditionally relied on indirect clinical signs and intracranial pressure (ICP) monitoring.
    • Direct imaging of tissue perfusion was previously unavailable in standard clinical settings.

    Observation:

    • A patient presented with a frontal lobe hematoma causing mass effect and brain stem compression, despite unchanged ICP readings.
    • Symptoms of brain stem compression indicated neurological compromise despite normal ICP monitoring.

    Findings:

    • Stable xenon-enhanced computed tomographic (CT) imaging directly visualized reduced cerebral blood flow (CBF) in the affected left frontal lobe and central ganglionic structures.
    • The xenon/CT scan provided crucial information on regional blood flow, complementing anatomical data from the standard head CT.

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    Implications:

    • Xenon/CT cerebral blood flow (CBF) mapping offers a valuable tool for understanding the pathophysiology of head injuries and mass lesions.
    • This imaging modality allows for direct assessment of tissue perfusion, potentially improving patient management and outcomes.