Hyperemia Beneath Evacuated Acute Subdural Hematoma Is Frequent and Prolonged in Patients With an Unfavorable Outcome

Chieregato, Arturo; Noto, Alberto; Tanfani, A.; Bini, Giovanni; Martino, Carmen; Fainardi, Enrico

doi:10.1227/01.neu.0000341872.17024.44

Cited by 20 publications

(18 citation statements)

References 59 publications

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“…(23) describes the time course of global CBF in 522 studies (unpublished data). A similar time course of rCBF has been observed in traumatic contusion by means of intravenous 133 Xenon [79], in traumatic intra-parenchymal hematoma [75] and in the cortex below the evacuated SDH by means of Xe-CT [44]. Although this pattern has been described in pooled patients with TBI it seems to characterize only patients with unfavorable outcome as shown in two studies in which data were dichotomized for favourable and unfavourable outcome [44,76].…”

Section: Time Course Of Cbfsupporting

confidence: 62%

“…Although this pattern has been described in pooled patients with TBI it seems to characterize only patients with unfavorable outcome as shown in two studies in which data were dichotomized for favourable and unfavourable outcome [44,76]. According to these studies, this pattern proved to apply to both global CBF [76] and regional CBF, at least in patients affected by isolated SDH [44].…”

Section: Time Course Of Cbfmentioning

confidence: 96%

“…Considering hyperemia, our recent paper [44] showed an association between focal cortical hyperemia beneath an evacuated subdural hematoma (SDH) and unfavourable outcome, without definition of the predictive values of threshold levels of hyperemia toward focal atrophy at CT. Similarly, an association, but not a prediction, between global hyperemia and unfavourable outcome was established by Kelly [45,46].…”

Section: When Why and How An Xe-ct Study Should Be Performed?mentioning

confidence: 99%

See 2 more Smart Citations

A Practical Approach to Interpretation of CBF Measured by Mean of Xenon-CT in Patients with Traumatic Brain Injury~!2010-03-08~!2010-03-29~!2010-09-14~!

Chieregato¹

2010

TONEUROSJ

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Abstract:The measurement of cerebral blood flow (CBF) in traumatic brain injury (TBI) by means of Xenon-CT (Xe-CT) has been part of the clinical practice of several centres since 1980. Xe-CT consists of a CBF image coupled with CT which offers the possibility to associate morphologic features given by CT with functional information. Today, Xe-CT, in association with Positron Emission Tomography (PET), represents the gold standard for clinical quantitative measurement of CBF. More recently, Xe-CT has improved its potential application in the intensive care unit by means of portable CT scanner. The aim of the present review is to describe the practical experience of a single center with over five hundred Xe-CT studies obtained in more than two hundred TBI patients, to provide a method to guide the lecture of images at bedside, to present illustrative cases and to review the literature published so far on Xe-CT and TBI. The physiological and clinical variables which may be useful to explain global and regional CBF are detailed. Global CBF and its relationship with ageing, the natural time course in TBI, and the dependency on physiological variables and therapy are discussed. The coupling of global CBF with cerebral metabolic rate of oxygen (CMRO2) and the relationship of arterial venous oxygen content differences (AVDO2) with patient outcome are analyzed. Finally, the current knowledge on regional CBF found in the most important traumatic lesions (posttraumatic cerebral infarction, contusion/laceration, acute subdural hematomas, and intraparenchymal hematoma) is described.Keywords: Arteriovenous difference of oxygen, cerebral blood flow, cerebral metabolic rate of oxygen, ischemia, outcome, traumatic brain injury, Xenon CT.

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Section: Time Course Of Cbfsupporting

confidence: 62%

Section: Time Course Of Cbfmentioning

confidence: 96%

Section: When Why and How An Xe-ct Study Should Be Performed?mentioning

confidence: 99%

See 1 more Smart Citation

A Practical Approach to Interpretation of CBF Measured by Mean of Xenon-CT in Patients with Traumatic Brain Injury~!2010-03-08~!2010-03-29~!2010-09-14~!

Chieregato¹

2010

TONEUROSJ

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“…Prolonged brain retraction may cause severe disturbance in the parenchymal biochemical patterns in the brain underlying an evacuated acute subdural hematoma leading to microthrombosis or vascular wall disintegration [14]. This combined with defective autoregulation and hyperemic long-lasting regional cerebral blood flow values can cause secondary bleeding leading to unfavorable outcome [2,8,10,15,16]. Bleeding has also been reported during the evacuation process [17].…”

Section: Discussionmentioning

confidence: 99%

Extra Investigation Might Be Necessary in High-Risk CT-Negative Cerebrovascular Cases

Walid¹,

Zaytseva²

2013

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Cerebrovascular accidents occur in elderly patients in whom neurodegenerative changes increase the risk of vascular permeation and concomitant intracranial bleeding. In rare cases, intracerebral massive hemorrhage happens in hospitalized patients with apparently stable clinical picture. We report two cases illustrating this phenomenon, discuss the possible pathomechanism involved in those tragic incidents and suggest possible prevention measures for these patients. A negative CT image in a patient with neurological symptoms, especially who are on warfarin with or without considerably elongated coagulation time, may be subject to a sudden intracranial hemorrhage. Microvascular abnormalities might be detected on perfusion CT imaging and should therefore be performed in all CT negative patients with close observation for 24 hours before contemplating discharge.

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“…Brainstem CBF measured at the level of the superior colliculus less than 40cc/100g/min has also been highly correlated with poor outcome [55]. A recent study showed that in patients with TBI who have evacuation of an acute subdural hematoma, that there is a persistent hyperemia under the area of evacuation, likely due to the metabolic disturbances described above, and furthermore, that this situation is associated with worse outcomes [56].…”

Section: Xenon/ct In Traumatic Brain Injurymentioning

confidence: 99%

Editorial - Neuromonitoring: The Concept of Targeted Therapy Revisited

Soustiel¹

2010

TONEUROSJ

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Abstract:Xenon/CT provides quantitative CBF data that has a proven record of being both safe and prognostic for decision making. The technique itself has been extensively validated. Modern equipment has allowed for integration of the data into immediate bedside decision-making with the use of a portable head CT scanner and improved data processing. The use of xenon/CT in decision making in traumatic brain injury may have a high utility in determining whether a specific treatment-whether it is hyperventilation, induced hypertension, or other intervention-is in fact helpful to the individual patient. This can allow for decision making based on an individual patient's physiology rather than generalized guidelines which may, in some cases, even be harmful.

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Hyperemia Beneath Evacuated Acute Subdural Hematoma Is Frequent and Prolonged in Patients With an Unfavorable Outcome

Abstract: On average, hyperemic long-lasting rCBF values frequently occur in the cortex located beneath an evacuated SDH and seem to be associated with unfavorable outcome.

Cited by 20 publications

References 59 publications

A Practical Approach to Interpretation of CBF Measured by Mean of Xenon-CT in Patients with Traumatic Brain Injury~!2010-03-08~!2010-03-29~!2010-09-14~!

A Practical Approach to Interpretation of CBF Measured by Mean of Xenon-CT in Patients with Traumatic Brain Injury~!2010-03-08~!2010-03-29~!2010-09-14~!

Extra Investigation Might Be Necessary in High-Risk CT-Negative Cerebrovascular Cases

Editorial - Neuromonitoring: The Concept of Targeted Therapy Revisited

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