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Hypertonic saline fluid therapy following brain stem trauma
1Neurosurgical Intensive Care Unit, Scientific Institute San Raffaele Hospital, Milan, Italy.
Journal of Neurosurgical Anesthesiology
|April 1, 1996
Summary
Hypertonic saline infusions improved neurological function and brainstem perfusion in a head trauma patient with vertebral artery vasospasm. This suggests hypertonic saline therapy may be beneficial for secondary ischemic injury.
Area of Science:
- Neurology
- Neurosurgery
- Critical Care Medicine
Background:
- Secondary ischemic injury is a significant concern after head trauma.
- Cerebrospinal trauma can lead to intracranial vertebral artery vasospasm and brainstem damage.
- Evoked potentials, such as SSEPs and BAEPs, are crucial for assessing neurological function.
Observation:
- A 14-year-old male with head trauma presented with tetraparesis and impaired somatosensory evoked potentials (SSEPs) and brainstem auditory evoked potentials (BAEPs) due to vasospasm.
- Two infusions of hypertonic saline (2.7% and 5.4%) were administered, followed by standard hypervolemic therapy.
Findings:
- The initial 2.7% hypertonic saline infusion improved SSEPs but not neurological status.
- The subsequent 5.4% hypertonic saline infusion led to further SSEP amelioration and improved motor function.
- Brainstem auditory evoked potentials remained unchanged throughout the treatment period. No complications were observed.
Implications:
- Hypertonic saline therapy may improve brainstem perfusion and contribute to neurological recovery in patients with head trauma and vasospasm.
- This case suggests a potential therapeutic role for hypertonic saline in managing secondary ischemic injury in specific neurotrauma cases.