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Hypertonic saline fluid therapy following brain stem trauma

M Gemma¹, S Cozzi, S Piccoli

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.

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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.

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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.