One of the most devastating diagnoses a neurosurgeon encounters is subarachnoid hemorrhage. A subarachnoid hemorrhage is a serious bleed into the brain. It is most commonly the result of an aneurysm, or out-pouching of a weakened artery, that bursts and releases blood into the space surrounding the brain.
Although rare, a subarachnoid hemorrhage can have devastating consequences. Furthermore, the symptoms are variable and nonspecific, including severe headache, stiff neck, slurred speech, nausea, vomiting or seizures.
Tragically, however, one of the earliest signs may be coma, or rapid loss of consciousness. This occurs when the brain is so deprived of oxygen and nutrients that brain cells stop functioning as they should. Patients with subarachnoid hemorrhage who have progressed to coma are very ill, needing close monitoring and intensive treatment.
Fortunately, at an acute-care facility like Columbia University Medical Center/NewYork-Presbyterian Hospital, state-of-the-art treatment is available at the Neuro-Intensive Care Unit (ICU). In the ICU, patients are monitored for signs of improvement as well as signs of complications. But what are the doctors looking for? Exactly what are all those monitors and probes doing, and what do the numbers mean?
The instruments in the ICU have become more and more sophisticated over the years. Using instruments that can be placed directly into the brain, physicians can now determine intracranial pressure, a measure of brain swelling; levels of chemicals, such as lactate, pyruvate and glucose, that tell doctors if the brain is using its fuel appropriately; the amount of blood flow in the brain; and the amount of oxygen available to brain cells.
The above measurements from the brain are combined with data gathered from other systems in the body—such as temperature, heart rate, blood pressure and breathing rate—to give providers a clearer picture of the patient’s status.
As the Surgical Director of the Neuro-Intensive Care Unit at Columbia, Dr. E. Sander Connolly heads up the team of specialists who care for the sickest comatose patients, including those who have suffered a subarachnoid hemorrhage.
Dr. Connolly knows that much of the treatment of comatose ICU patients involves knowing what’s going on with the various systems that keep the body going. How do the heart, lungs and blood vessels affect the brain’s functioning? Are there things we can do to help those systems help the brain?
In a recent article published in PLOS ONE, Dr. Connolly and his colleagues* looked at the relationships among the different types of physical data collected from ICU patients at Columbia. Using advanced statistical methods, they were able to show the complex relationships between the body’s—and the brain’s—general physical signs.
The data collected in the study by Dr. Connolly and his colleagues will give us insight into how changes in the body’s functions—including those that can be controlled by treatments in the ICU—affect the brain’s health and ability to recover.
Among the many findings, for example, it appears that heart function and blood pressure are strongly tied to the amount of oxygen in the brain. While in the early days after subarachnoid hemorrhage, brain swelling may depend on the amount of fluid in the body, later on the amount of oxygen in the brain may be more important in determining swelling.
The more we know about how the body’s functions are interrelated—how A affects B—the better we’ll know how to treat coma from subarachnoid hemorrhage.
*Full list of authors: Jan Claassen, Shah Atiqur Rahman, Yuxiao Huang, Hans-Peter Frey, J. Michael Schmidt, David Albers, Cristina Maria Flao, Soojin Park, Sachin Agarwal, E. Sander Connolly, Samantha Kleinberg
Image Credit: © [igoraul] /Adobe Images
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