Brain hypoperfusion post-resuscitation

Sequential magnetic resonance imaging changes after suspected global brain ischaemia in a dog

Sequential magnetic resonance imaging studies over a period of 18 months were performed in a two-year-old pug dog after suspected global brain ischaemia following an anaesthetic accident. The dog was presented with seizures and neurological deficits consistent with a left brainstem and multifocal/diffuse forebrain lesion after an asymptomatic interval of 72 hours following the ischaemic event. Magnetic resonance imaging scans were performed three hours, six weeks, seven and 18 months after the incident. In the acute stage, signal hyperintensity was evident in the occipital and parietal regions of the cerebral cortex and in both rostral caudate nuclei. Slight involvement of the white matter was also noticed. In the chronic phase, the signal hyperintensity in the affected areas of the cortex was diminished and smaller in size, whereas the white matter did not appear to be compromised anymore.

Head trauma

No definitive, clinically proven drug therapy currently exists for reversal or amelioration of the injurious cellular events initiated by head trauma. The patient's physiologic status should therefore be monitored and managed as best as possible bearing in mind all the factors that can aggravate intracranial abnormalities. All treatment options have positive and negative aspects that should be considered and balanced on an individual patient basis. A major concern in the management of head-injured patients is the avoidance or treatment of intracranial hypertension. This may be achieved largely through medical means and accurate efforts can only be made if intracranial pressure and the variables that influence it are monitored directly. A definite place exists for surgery in the management of head-injured patients, though such a decision is best guided by objective evaluation of the intracranial vault.