Risk factors for the development of post-traumatic cerebral vasospasm

Zubkov, Alexander Y.; Lewis, Adam I.; Raila, Frank A.; Zhang, Junyi; Parent, Andrew D.

doi:10.1016/s0090-3019(99)00178-0

Cited by 78 publications

(67 citation statements)

References 21 publications

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“…14,25 Mechanical factors have been implicated in the pathogenesis of PTV, with in vitro studies showing that vasospasm can occur from mechanical manipulation or irritation, although experimentally it is sustained for a shorter time than is seen clinically. 5,42 Stretching of cerebral vessels during blast injuries has also been proposed as a cause of PTV without cisternal or subarachnoid blood. 14 Although the pathophysiology of cerebral vasospasm continues to be a topic of debate, there is a general consensus that spasmogenic and neuroinflammatory substances generated from lysis of subarachnoid blood propagate the process.…”

Section: Pathophysiologymentioning

confidence: 99%

“…Severe SAH has consistently been linked to a high incidence of PTV, 25,42 with some studies showing an increased predilection for developing PTV in cases of intracerebral hematoma. 25 An increased incidence of PTV has also been reported in some cases of epidural and subdural hematomas.…”

Section: Predictors Of Ptvmentioning

confidence: 99%

“…25 An increased incidence of PTV has also been reported in some cases of epidural and subdural hematomas. 42 Certain clinical presentations have also been shown to correlate with an increased risk of developing PTV. Shahlaie et al showed that fever was independently associated with PTV.…”

Section: Predictors Of Ptvmentioning

confidence: 99%

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Traumatic brain injury and intracranial hemorrhage–induced cerebral vasospasm: a systematic review

Al‐Mufti

Amuluru²,

Changa³

et al. 2017

Neurosurgical Focus

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OBJECTIVELittle is known regarding the natural history of posttraumatic vasospasm. The authors review the pathophysiology of posttraumatic vasospasm (PTV), its associated risk factors, the efficacy of the technologies used to detect PTV, and the management/treatment options available today.METHODSThe authors performed a systematic review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the following databases: PubMed, Google Scholar, and CENTRAL (the Cochrane Central Register of Controlled Trials). Outcome variables extracted from each study included epidemiology, pathophysiology, time course, predictors of PTV and delayed cerebral ischemia (DCI), optimal means of surveillance and evaluation of PTV, application of multimodality monitoring, modern management and treatment options, and patient outcomes after PTV. Study types were limited to retrospective chart reviews, database reviews, and prospective studies.RESULTSA total of 40 articles were included in the systematic review. In many cases of mild or moderate traumatic brain injury (TBI), imaging or ultrasonographic studies are not performed. The lack of widespread assessment makes finding the true overall incidence of PTV a difficult endeavor. The clinical consequences of PTV are important, given the morbidity that can result from it. DCI manifests as new-onset neurological deterioration that occurs beyond the timeframe of initial brain injury. While there are many techniques that attempt to diagnose cerebral vasospasm, digital subtraction angiography is the gold standard. Some predictors of PTV include SAH, intraventricular hemorrhage, low admission Glasgow Coma Scale (GCS) score (< 9), and young age (< 30 years).CONCLUSIONSGiven these results, clinicians should suspect PTV in young patients presenting with intracranial hemorrhage (ICH), especially SAH and/or intraventricular hemorrhage, who present with a GCS score less than 9. Monitoring and regulation of CNS metabolism following TBI/ICH-induced vasospasm may play an important adjunct role to the primary prevention of vasospasm.

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Section: Pathophysiologymentioning

confidence: 99%

Section: Predictors Of Ptvmentioning

confidence: 99%

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Traumatic brain injury and intracranial hemorrhage–induced cerebral vasospasm: a systematic review

Al‐Mufti

Amuluru²,

Changa³

et al. 2017

Neurosurgical Focus

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“…What is known is that the incidence of vasospasm after trauma increases with the amount of traumatic SAH present on the admission head CT, 31,32,36 that the incidence of vasospasm is inversely proportional to admission Glasgow Coma Scale scores, 6,36,37 that the vasospasm can be reliably monitored with TCD ultrasonography, 7,31,32,34 and the time course of spasm in this setting is variable. 6,31,32,36,37 There is, however, continued debate concerning whether, like aneurysmal SAH vasospasm, traumatic vasospasm causes delayed ischemic neurological deficits and worsens outcomes. 6,15,32 It is because of this debate that, prior to 2006, very few studies were available that evaluated the effect of endovascular treatment interventions in this setting.…”

Section: Traumatic Vasospasmmentioning

confidence: 99%

“…While previous studies characterized the formation of vasospasm following trauma, 19,20,22,23,29,31,32,36,37 few were able to correlate delayed ischemic deficits and outcomes with its presence, 15,31,32,37 and even fewer described the safety or efficacy of endovascular interventions in this setting. 12 In addition, while not specifically correlated with vasospasm occurrence, there was a considerable predominance of blast-induced head injury in our population.…”

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confidence: 99%

The evolution of the treatment of traumatic cerebrovascular injury during wartime

Bell

Ecker

Severson³

et al. 2010

FOC

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The approach to traumatic craniocervical vascular injury has evolved significantly in recent years. Conflicts prior to Operations Iraqi and Enduring Freedom were characterized by minimal intervention in the setting of severe penetrating head injury, in large part due to limited far-forward resource availability. Consequently, sequelae of penetrating head injury like traumatic aneurysm formation remained poorly characterized with a paucity of pathophysiological descriptions. The current conflicts have seen dramatic improvements with respect to the management of severe penetrating and closed head injuries. As a result of the rapid field resuscitation and early cranial decompression, patients are surviving longer, which has led to diagnosis and treatment of entities that had previously gone undiagnosed. Therefore, in this paper the authors' purpose is to review their experience with severe traumatic brain injury complicated by injury to the craniocervical vasculature. Historical approaches will be reviewed, and the importance of modern endovascular techniques will be emphasized.

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Cerebral Vasospasm after Subarachnoid Hemorrhage

Newell

Alexandrov

2004

Cerebrovascular Ultrasound in Stroke Prevention and Treatment

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Risk factors for the development of post-traumatic cerebral vasospasm

Cited by 78 publications

References 21 publications

Traumatic brain injury and intracranial hemorrhage–induced cerebral vasospasm: a systematic review

Traumatic brain injury and intracranial hemorrhage–induced cerebral vasospasm: a systematic review

The evolution of the treatment of traumatic cerebrovascular injury during wartime

Cerebral Vasospasm after Subarachnoid Hemorrhage

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