Situating Cerebral Blood Flow in the Pathotrajectory of Head Trauma

Graves, Justin; Betrus, Christopher; Rafols, José A.

doi:10.1007/978-1-4614-4148-9_2

Cited by 3 publications

(2 citation statements)

References 95 publications

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“…27 Molecular models focus around endothelin-1 protein and its effect on endothelin receptor A. CSF and serum obtained in patients who have sustained a TBI show increased levels of endothelin-1, supporting its involvement in TBI and subsequent vasospasm in these patients. 8 PTV results in diminished blood flow to areas of the brain, producing DCI and manifesting in new-onset neurological deterioration occurring after initial brain injury. 21 Westermaier et al found neurological evaluation to be the most accurate method for discovering vasospasm or infarction following aSAH.…”

Section: Pathophysiologymentioning

confidence: 99%

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%

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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“…Secondary processes also contribute to vessel narrowing and spasm. These include the chronic depolarization of vascular smooth muscle due to reduced potassium channel activity, the breakdown of blood products resulting in endothelin release and reduced availability of nitric oxide, free radical formation, cyclic GMP depletion of vascular smooth muscle, and potentiation of prostaglandin-induced vasoconstriction [ 41 , 42 , 43 ]. Whether VSP becomes symptomatic depends on several clinical factors.…”

Section: Pathophysiologymentioning

confidence: 99%

Post-Traumatic Cerebral Infarction: A Narrative Review of Pathophysiology, Diagnosis, and Treatment

Poblete,

Zhong,

Patel

et al. 2024

Neurology International

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Traumatic brain injury (TBI) is a common diagnosis requiring acute hospitalization. Long-term, TBI is a significant source of health and socioeconomic impact in the United States and globally. The goal of clinicians who manage TBI is to prevent secondary brain injury. In this population, post-traumatic cerebral infarction (PTCI) acutely after TBI is an important but under-recognized complication that is associated with negative functional outcomes. In this comprehensive review, we describe the incidence and pathophysiology of PTCI. We then discuss the diagnostic and treatment approaches for the most common etiologies of isolated PTCI, including brain herniation syndromes, cervical artery dissection, venous thrombosis, and post-traumatic vasospasm. In addition to these mechanisms, hypercoagulability and microcirculatory failure can also exacerbate ischemia. We aim to highlight the importance of this condition and future clinical research needs with the goal of improving patient outcomes after TBI.

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Human Cerebral Blood Flow and Traumatic Brain Injury

Hovda

Glenn

2013

Vascular Mechanisms in CNS Trauma

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Situating Cerebral Blood Flow in the Pathotrajectory of Head Trauma

Cited by 3 publications

References 95 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

Post-Traumatic Cerebral Infarction: A Narrative Review of Pathophysiology, Diagnosis, and Treatment

Human Cerebral Blood Flow and Traumatic Brain Injury

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