Cushing reflex: A sign of vessel perforation during mechanical thrombectomy performed under general anesthesia

We aimed to present the assessment of the Cushing reflex caused by intracranial haemorrhagia developing during mechanical thrombectomy in a case presenting with acute ischemic stroke. A 59-year old male patient was scanned by CT angio due to speaking disorder and right lateral weakness developing 5 hours earlier. Acute infarction was observed in the left MCA irrigation area with M1 segment occlusion observed in the left MCA. The decision was made to treat the patient with mechanical thrombectomy and he was transferred to the interventional neuroradiology unit. Under general anesthesia during navigation of the thromboaspiration catheter to the clot localization as the procedure was technically advancing routinely, with sudden development of bradycardia and hypertension the anesthesiology team was warned and 1 mg IV atropine was administered for bradycardia. Acute infarction has to be removed because it is understood as mechanical thrombectomy has been performed to a patient with an infarction. Simultaneously contrast material injection through the guide catheter showed the MCA M1 segment had ruptured and extravasation had developed. As conclusion, anesthesia and operation team must be alert for vessel perforation when Cushing triad develops during navigation of the thromboaspiration catheter

Isotropization of N-component orthogonal fluid within the framework of Einstein field equations

© 2022 Elsevier B.V.In this study, we build up a general formalism for tilted N-component fluid form to investigate the isotropization features of the Bianchi-type models excluding Bianchi-IX. We applied this formalism to Bianchi type I and V models analytically and numerically using the metric approach of Einstein field equations. It is found that only the stiff fluid for Bianchi I model does not isotropize, in the absence of cosmological constant. Other Bianchi type I and V models become isotropic regardless of the type of the fluid or how much component it has. The result does not change with the existence of a cosmological constant