Early and persistent impaired percent alpha variability on continuous electroencephalography monitoring as predictive of poor outcome after traumatic brain injury

Vespa, Paul; Boscardin, W. John; Hovda, David A.; McArthur, David L.; Nuwer, Marc R.; Martin, Neil A.; Nenov, Valeriy; Glenn, Thomas C.; Bergsneider, Marvin; Kelly, Daniel F.; Becker, Donald P.

doi:10.3171/jns.2002.97.1.0084

Cited by 130 publications

(89 citation statements)

References 53 publications

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“…These techniques include jugular venous bulb monitoring, 11 brain tissue oxygenation, 23,39 microdialysis, 26,38 and continuous monitoring with electroencephalography. 40 However, aside from the large amount of data that these monitoring techniques provide, none has been found to have significant independent predictive value significance. 4,20,38,42,43 Our aim with this study was to determine whether disruption of the blood-brain barrier (BBB) could act as a marker of secondary brain injury and therefore provide independent prognostic information.…”

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confidence: 99%

Prognostic significance of blood-brain barrier disruption in patients with severe nonpenetrating traumatic brain injury requiring decompressive craniectomy

Honeybul

Yip

et al. 2014

JNS

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Object The authors assessed the risk factors and outcomes associated with blood-brain barrier (BBB) disruption in patients with severe, nonpenetrating, traumatic brain injury (TBI) requiring decompressive craniectomy. Methods At 2 major neurotrauma centers in Western Australia, a retrospective cohort study was conducted among 97 adult neurotrauma patients who required an external ventricular drain (EVD) and decompressive craniectomy during 2004–2012. Glasgow Outcome Scale scores were used to assess neurological outcomes. Logistic regression was used to identify factors associated with BBB disruption, defined by a ratio of total CSF protein concentrations to total plasma protein concentration > 0.007 in the earliest CSF specimen collected after TBI. Results Of the 252 patients who required decompressive craniectomy, 97 (39%) required an EVD to control intracranial pressure, and biochemical evidence of BBB disruption was observed in 43 (44%). Presence of disruption was associated with more severe TBI (median predicted risk for unfavorable outcome 75% vs 63%, respectively; p = 0.001) and with worse outcomes at 6, 12, and 18 months than was absence of BBB disruption (72% vs 37% unfavorable outcomes, respectively; p = 0.015). The only risk factor significantly associated with increased risk for BBB disruption was presence of nonevacuated intracerebral hematoma (> 1 cm diameter) (OR 3.03, 95% CI 1.23–7.50; p = 0.016). Although BBB disruption was associated with more severe TBI and worse long-term outcomes, when combined with the prognostic information contained in the Corticosteroid Randomization after Significant Head Injury (CRASH) prognostic model, it did not seem to add significant prognostic value (area under the receiver operating characteristic curve 0.855 vs 0.864, respectively; p = 0.453). Conclusions Biochemical evidence of BBB disruption after severe nonpenetrating TBI was common, especially among patients with large intracerebral hematomas. Disruption of the BBB was associated with more severe TBI and worse long-term outcomes, but when combined with the prognostic information contained in the CRASH prognostic model, this information did not add significant prognostic value.

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confidence: 99%

Prognostic significance of blood-brain barrier disruption in patients with severe nonpenetrating traumatic brain injury requiring decompressive craniectomy

Honeybul

Yip

et al. 2014

JNS

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“…Continuous monitoring of electroencephalography (EEG) and near-infrared spectroscopy (NIRS) could be safely possible in the intensive care unit. 15,16) EEG monitoring may be useful for indicating outcomes in patients with traumatic brain injury. 16) NIRS may be useful for evaluating brain ischemia.…”

Section: Discussionmentioning

confidence: 99%

Hemispheric Laminar Necrosis as a Complication of Traumatic Carotid-Cavernous Sinus Fistula -Case Report-

Kato

Ikegame

Toyoda

et al. 2009

Neurol. Med. Chir.(Tokyo)

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A 43-year-old woman presented with a very rare case of hemispheric laminar necrosis as a complication of traumatic carotid-cavernous sinus fistula (CCF). The patient suffered head injury and extensive burns following a car accident. Oral intubation was performed under sedation. When sedation was discontinued 17 days after injury, the patient demonstrated left hemiparesis. Magnetic resonance imaging showed laminar necrosis affecting the right cerebral hemisphere. Angiography revealed a right highflow direct CCF. Transarterial embolization of the fistula using a detachable balloon achieved complete occlusion of the fistula. However, the left hemiparesis persisted following this intervention. Traumatic CCF may be missed in patients with disturbed consciousness, so clinicians should not overlook possibility of the triad of symptoms of CCF in patients with head injury.

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“…This can help guide therapy with anticonvulsant medications which can also have multiple and significant adverse effects such as fever, hemodynamic changes such as hypotension, delirium, encephalopathy, and somnolence in patients who have temporal lobe contusions, subdural hematomas, or depressed skull fractures which may have a higher risk of seizures. From a prognostication standpoint, EEG has also been found to correlate with clinical outcomes in traumatic brain injury patients with reduced percent alpha variability (PAV) being a key predictor of poor functional clinical outcome at 30 days and 6 months post-trauma as well as thalamic involvement [52]. The alpha-delta ratio has also been studied in small cohorts and been found to correlate with outcome after rehabilitation [53].…”

Section: Continuous Eeg Monitoring and Electrocorticographymentioning

confidence: 99%

The Role of Invasive Monitoring in Traumatic Brain Injury

Carandang

2015

Curr Trauma Rep

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Severe traumatic brain injury is a complex disease that involves physical injury and distortion of tissues and cell membranes, gross hemodynamic changes including loss of autoregulation, cerebral edema and tissue shifts, changes in pressure and perfusion and multiple secondary cellular processes including electrolyte fluxes, inflammatory mediator release, neurotransmitter mediated excitotoxicity, apoptosis, mitochondrial dysfunction, and alterations in cellular metabolism. The optimal treatment of these patients who have severe neurological dysfunction or require sedation that compromises neurological functional assessment by physical examination requires the monitoring and management of multiple aspects of brain physiology including pressure, perfusion, oxygenation, cellular metabolism, and electrical activity. Invasive monitoring techniques, while still in various stages of development, can and will provide real-time trackable data that informs the management of these patients as well as contributes to our understanding of the pathophysiological processes that contribute to it.

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Early and persistent impaired percent alpha variability on continuous electroencephalography monitoring as predictive of poor outcome after traumatic brain injury

Abstract: Continuous EEG monitoring performed with particular attention paid to the PAV is a sensitive and specific method of prognosis that can indicate outcomes in patients with moderate to severe TBI within 3 days postinjury.

Cited by 130 publications

References 53 publications

Prognostic significance of blood-brain barrier disruption in patients with severe nonpenetrating traumatic brain injury requiring decompressive craniectomy

Prognostic significance of blood-brain barrier disruption in patients with severe nonpenetrating traumatic brain injury requiring decompressive craniectomy

Hemispheric Laminar Necrosis as a Complication of Traumatic Carotid-Cavernous Sinus Fistula -Case Report-

The Role of Invasive Monitoring in Traumatic Brain Injury

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