Int J Angiol 2023; 32(03): 188-192
DOI: 10.1055/s-0043-1763252
Rapid Communication

Intracranial Hypertension following Acute Mesenteric Ischemia: A Case Study on the Multiple Compartment Syndrome

Derek O. Pipolo*
1   Department of Surgery, North Shore University Hospital, Manhasset, New York
2   Department of Neurological Surgery, Trauma and Emergency Hospital Dr. Federico Abete, Buenos Aires, Argentina
,
Sara Guevara*
1   Department of Surgery, North Shore University Hospital, Manhasset, New York
,
Lana Vasiljevic
3   Department of Pediatrics, LAC + USC Medical Center, Los Angeles, California
,
Andres E. Di Pietrantonio
2   Department of Neurological Surgery, Trauma and Emergency Hospital Dr. Federico Abete, Buenos Aires, Argentina
,
Walter Brennan
2   Department of Neurological Surgery, Trauma and Emergency Hospital Dr. Federico Abete, Buenos Aires, Argentina
,
Humberto Asmus
2   Department of Neurological Surgery, Trauma and Emergency Hospital Dr. Federico Abete, Buenos Aires, Argentina
,
Alexia McCann-Molmenti
1   Department of Surgery, North Shore University Hospital, Manhasset, New York
,
Young Min Cho
4   Department of Rheumatology, North Shore University Hospital, Manhasset, New York
,
Koichiro Shinozaki
5   Feinstein Institutes for Medical Research, Manhasset, New York
6   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
,
Kei Hayashida
5   Feinstein Institutes for Medical Research, Manhasset, New York
,
Yu Okuma
7   Department of Neurological Surgery, Sonoda Daiichi Hospital, Tokyo, Japan
,
Muhammad Shoaib
5   Feinstein Institutes for Medical Research, Manhasset, New York
8   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
,
Lance B. Becker
5   Feinstein Institutes for Medical Research, Manhasset, New York
6   Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
8   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
,
Mary E. Decker
9   Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Hermoon A. Worku
9   Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Petra Majdak
9   Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Grace Donzelli
9   Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Akash Patel
9   Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Sherwin Davoud
9   Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Andres Vaca-Zorrilla
9   Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Sascha S. Beutler
9   Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Ernesto P. Molmenti
1   Department of Surgery, North Shore University Hospital, Manhasset, New York
5   Feinstein Institutes for Medical Research, Manhasset, New York
8   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
,
Santiago J. Miyara
9   Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
› Author Affiliations

Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Preview

Abstract

In this case study, we describe a 25-year-old male who was admitted due to a severe traumatic brain injury, requiring invasive intracranial pressure monitoring. At 48 hours posttrauma, he developed intracranial hypertension refractory to medical treatment without tomographic changes in the brain. Subsequently, intra-abdominal hypertension and tomographic signs of abdominal surgical pathology were observed. An exploratory laparotomy was performed with an intraoperative diagnosis of acute mesenteric ischemia. After surgical intervention for the abdominal pathology, intracranial pressure was restored to physiological values with a favorable recovery of the patient. In this report, the relationship between intracranial pressure and intra-abdominal pressure is discussed, highlighting the delicate association between the brain, abdomen, and thorax. Measures should be taken to avoid increases in intra-abdominal pressure in neurocritical patients. When treating intracranial hypertension refractory to conventional measures, abdominal causes and multiple compartment syndrome must be considered. The cranial compartment has physiological interdependence with other body compartments, where one can be modified by variations from another, giving rise to the concept of multiple compartment syndrome. Understanding this relationship is fundamental for a comprehensive approach of the neurocritical patient. To the best of our knowledge, this is the first report of a comatose patient post-traumatic brain injury, who developed medically unresponsive intracranial hypertension secondary to acute mesenteric ischemia, in which surgical resolution of intra-abdominal pathology resulted in intracranial pressure normalization and restitutio ad integrum of neurological status.

* These authors had equal contribution.




Publication History

Article published online:
09 March 2023

© 2023. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA