Cerebral Blood Flow in Acute Head Injury

During the last decade a multitude of studies concerning the dynamic changes in cerebral blood flow (CBF), cerebral metabolic rate of oxygen (CMRO2), and intracranial pressure (ICP) in the acute phase after head injury have been published. These studies have been supplemented with studies of cerebral autoregulation, CO2 reactivity and barbiturate reactivity. Other investigations include studies of cerebrospinal fluid pH, bicarbonate, lactate and pyruvate. In this book experimental and clinical studies of the dynamic changes in CBF, CMRO2, CO2 reactivity and barbiturate reactivity are reviewed. The author's own clinical studies of the dynamic changes in CBF and cerebral metabolism are summarized and discussed, and the therapeutical implication as regards the use of artificial hyperventilation, sedation with barbiturate and mannitol treatment are discussed.

Inhalt

1. Measurement and Cerebral Blood Flow (CBF) and Oxygen Consumption, and the Regulation of Cerebral Circulation.- Experimental Studies of Cerebral Blood Flow.- Measurement of Cerebral Blood Flow (Human Studies).- Human Studies of Cerebral Metabolic Rate of Oxygen (CMRO,).- Hypothermia.- CO2 Reactivity and Adaptation to Prolonged Hyperventilation.- The Use of Prolonged Continuous Hyperventilation. Pro et contra.- Cerebral Autoregulation (CA).- 2. Ischaemic Thresholds and Development of Ischaemia.- 3. The Effect of Barbiturate and Mannitol on CBF and Metabolism.- Barbiturate: Experimental Studies.- Human Investigations.- Mannitol.- Mannitol and Blood-Brain Barrier (BBB).- 4. Experimental Studies of Head Injury.- 5. Human Studies of Head Injury.- ICP Recordings in Patients with Head Injury.- Biochemical Studies of CSF.- 6. The Author's Own Studies.- CBF and CMRO2 in the Acute Phase of Head Injury (Own Studies).- Presentation of the Study and the Investigational Methods Used.- Repeated Studies of CBF.- Studies of CMRO2.- Studies of Relationship Between CMRO2 and CBF.- Repeated Studies of Cerebral Autoregulation.- Studies of Cerebral Autoregulation During Two Levels of PaCO2.- Studies of CO2 Reactivity.- Studies of Barbiturate- and CO2 Reactivities.- Summary of the Nine Studies.- Discussion of the Results.- Summary Concerning Dynamic Changes in Cerebral Circulation and Metabolism.- Therapeutic Considerations.- Future Studies of Cerebral Circulation and Metabolism in the Acute Phase of Head Injury.- Summary.- References.