Marked Regional Heterogeneity in Venous Oxygen Saturation in Severe Head Injury Studied by Superselective Intracranial Venous Sampling: Case Report

Marked Regional Heterogeneity in Venous Oxygen Saturation in Severe Head Injury Studied by... AbstractOBJECTIVE:Continuous monitoring of jugular venous oxygen saturation (SivO2) is useful in the management of severe head injury, abnormally high SjvO2 values can be caused by increased cerebral blood flow, decreased cerebral metabolism, brain death, contamination from extracerebral venous blood, or traumatic arteriovenous fistula.CLINICAL PRESENTATION:A 20-year-old man with severe head injury was diagnosed to have a traumatic dural carotid-cavernous sinus fistula on the day of trauma. Continuous left SjvO2 monitoring from Days 4 to 12 revealed oxygen saturation ranging between 85 and 98%.INTERVENTION:Superselective intracranial and extracranial venous sampling on Day 5 demonstrated marked regional heterogeneity in venous oxygen saturation as fallows: superior sagittal sinus, 95 to 97%; straight sinus, 88%; right trtansverse sinus, 94%; left transverse sinus, 74%; right SjvO2, 95%; left SjvO2, 89%; the basilar plexus, 99%; right intetnal jugular vein, 98%; the left internal jugular vein, 94%, Extremely high oxygen saturation in the superior sagittal sinus and basilar plexus was attributed to severe brain damage and carotid-cavernous sinus fistula, respectively.CONCLUSION:Although jugular bulb oximetry is useful in the management of severe head injury, high oxygen saturation values should be interpreted with caution because they cannot show the intracranial heterogeneity of venous oxygen saturation. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Marked Regional Heterogeneity in Venous Oxygen Saturation in Severe Head Injury Studied by Superselective Intracranial Venous Sampling: Case Report

Marked Regional Heterogeneity in Venous Oxygen Saturation in Severe Head Injury Studied by Superselective Intracranial Venous Sampling: Case Report

J u g u l a r B u l b O x i m e t r y 1469 S j v 0 2 level was abnormally high. Super- Marked Regional Heterogeneity in selective intracranial venous sampling, however, revealed marked regional het­ Venous Oxygen Saturation in Severe erogeneity of venous oxygen saturation. We discuss heterogeneous oxygen satu­ Head Injury Studied by Superselective ration and the usefulness of continuous S j v 0 2 m onitoring in severe head injury. Intracranial Venous Sampling: Case Report CASE PRESEN TATIO N A 20-year-old m an with a severe head injury was transferred to us in a state of cardiopulm onary arrest as a result of M a s a k i K o m i y a m a , M . D . , M a s a n o r i K a n , M . D . , massive oronasal bleeding. His blood T a t s u h i r o S h i g e m o t o , M . D . , A r i t o K a j i , M . D . pressure was not m easurable, and his heart rate was 30 to 40 beats/m inute at Departments of Neurosurgery (M Ko) and Critical Care and Emergency Medicine (MKa, TS AK), Osaka City General Hospital, Osaka, Japan admission. No respiration was ob­ served. G lasgow C om a Scale (19) score was 3. His pupils were anisocoric and unreactive to light (right, 6.0 m m ; left, OBJECTIVE: Continuous monitoring of jugular venous oxygen saturation 5.0 mm). A com puted tom ographic scan (SivO,) is useful in the management of severe head injury, abnormally of the brain revealed marked pneum o- high SjvO 2 values can be caused by increased cerebral blood flow, cephalus in the subarachnoid and su b­ decreased cerebral metabolism, brain death, contamination from extra­ dural spaces {Fig. IA ). After successful cardiopulm onary resuscitation and cerebral venous blood, or traum atic arteriovenous fistula. massive blood transfusion, diagnostic CLINICAL PR ESEN T A T IO N : A 20-year-old man with severe headm ury^was and therapeutic angiography was p er­ diagnosed to have a traum atic dural carotid-cavernous *nus fistula on the formed 80 m inutes after trauma. Active day of...
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Publisher
Oxford University Press
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199912000-00040
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVE:Continuous monitoring of jugular venous oxygen saturation (SivO2) is useful in the management of severe head injury, abnormally high SjvO2 values can be caused by increased cerebral blood flow, decreased cerebral metabolism, brain death, contamination from extracerebral venous blood, or traumatic arteriovenous fistula.CLINICAL PRESENTATION:A 20-year-old man with severe head injury was diagnosed to have a traumatic dural carotid-cavernous sinus fistula on the day of trauma. Continuous left SjvO2 monitoring from Days 4 to 12 revealed oxygen saturation ranging between 85 and 98%.INTERVENTION:Superselective intracranial and extracranial venous sampling on Day 5 demonstrated marked regional heterogeneity in venous oxygen saturation as fallows: superior sagittal sinus, 95 to 97%; straight sinus, 88%; right trtansverse sinus, 94%; left transverse sinus, 74%; right SjvO2, 95%; left SjvO2, 89%; the basilar plexus, 99%; right intetnal jugular vein, 98%; the left internal jugular vein, 94%, Extremely high oxygen saturation in the superior sagittal sinus and basilar plexus was attributed to severe brain damage and carotid-cavernous sinus fistula, respectively.CONCLUSION:Although jugular bulb oximetry is useful in the management of severe head injury, high oxygen saturation values should be interpreted with caution because they cannot show the intracranial heterogeneity of venous oxygen saturation.

Journal

NeurosurgeryOxford University Press

Published: Dec 1, 1999

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