TITLE:
Prospective Evaluation of Post-Traumatic Vasospasm and Post-Injury Functional Outcome Assessment: Is Cerebral Ischemia Going Unrecognized in Patients with Traumatic Brain Injury?
AUTHORS:
Cherisse Berry, Jamila Torain, Joseph A. Kufera, Peter F. Hu, Thomas M. Scalea, Deborah M. Stein
KEYWORDS:
Traumatic Brain Injury, Vasospasm, Cerebral Ischemia
JOURNAL NAME:
Journal of Behavioral and Brain Science,
Vol.7 No.8,
August
17,
2017
ABSTRACT: Background: Secondary
injury processes such as posttraumatic vasospasm (PTV) play a critical role in
the development of cerebral ischemia/infarction after traumatic brain injury
(TBI). The objectives of this study were to evaluate the incidence of cerebral
vasospasm in patients with moderate to severe TBI and to assess post-injury
functional outcome. Study Design: A prospective observational study was
conducted in patients with moderate and severe blunt TBI. Transcranial Doppler
(TCD) ultrasound was performed within the first 72 hours and then daily for up
to 7 days. Patient characteristics and outcome data including functional outcome
as assessed by the Extended Glasgow Outcome Scale (GOS-E) were collected and
compared between patients with and without PTV. Results: Twenty-three
patients met our inclusion criteria. While there was a 47.8% incidence of
vasospasm as detected by TCD, there was no significant difference in hospital
LOS or mortality between patients with and without PTV. Of the two patients
with PTV who died, both had a cerebral infarct or cerebral ischemia. In
evaluating overall GOS-E among patients with a cerebral focal injury, patients
with PTV had a significantly higher GOS-E score when compared to patients without
PTV (8.0 vs. 6.8, p = 0.01). Conclusions: The high incidence of PTV and the role of clinically significant vasospasm
after TBI remain unclear. While functional outcome was better in patients with
a focal injury and vasospasm, patients who died had cerebral ischemia or
infarction. We hypothesize that there is an interaction between impaired
cerebral autoregulation, PTV and poor outcomes in patients with TBI.