Transiently Increased Basilar Artery Flow Velocity following Severe Head Injury: A Time Course Transcranial Doppler Study

Abstract

A significant number of patients develop increased flow velocities compatible with vasospasm in the basilar artery after severe head injury. This phenomenon may represent an additional factor that contributes to the poor outcome of severely head-injured patients.

Posttraumatic Vasospasm Detected by Continuous Brain Tissue Oxygen Monitoring: Treatment with Intraarterial Verapamil and Balloon Angioplasty

“…PTV has also been associated with the presence of intracranial hemorrhage following TBI [8,12,17,31,32,41], but the distribution of that hemorrhage varies among studies. For example, Hadani et al [8] found the incidence of PTV in the anterior or posterior circulation increased from 43% to 58% if traumatic subarachnoid hemorrhage (tSAH) was present.…”

“…For example, Hadani et al [8] found the incidence of PTV in the anterior or posterior circulation increased from 43% to 58% if traumatic subarachnoid hemorrhage (tSAH) was present. Romner et al [15] found anterior circulation PTV incidence increased from 28% to 41% with tSAH, a correlation that has been further supported by other authors as well [12,24,31,32].…”

“…Although there is significant data suggesting that PTV is significantly correlated with ischemia, neurological deficits [3,4,6,7,10,[22][23][24][25] and/or death [8,[69][70][71], there are no published guidelines for its detection and treatment. Both 133 Xe CBF [11] and SPECT [15] studies have shown that middle cerebral artery spasm is strongly associated with cerebral ischemia and PTV of the basilar artery is strongly associated with worse outcome [3,18,20].…”

“…Both 133 Xe CBF [11] and SPECT [15] studies have shown that middle cerebral artery spasm is strongly associated with cerebral ischemia and PTV of the basilar artery is strongly associated with worse outcome [3,18,20]. Hadani et al [8] found that patients with basilar artery velocity above 90 cm/ s following TBI have a 33% chance of death and 42% chance of being vegetative 6 months after injury. In a study by Soustiel et al [20], patients with traumatic SAH and subsequent severe basilar artery spasm had an 85.3% chance of experiencing permanent neurological deficit or death.…”

“…Initial reports from a single, early angiogram used to evaluate patients with head injury (prior to CT scans) estimated its incidence to be between 10% and 15% [3][4][5][6]. Serial screening with more modern techniques, however, have revealed the true incidence of PTV to be between 18.6% and 50% in the anterior circulation [6][7][8][9][10][11][12][13][14][15][16][17], and 19% and 37% in the posterior circulation [7,18,19]. PTV typically develops between 12 h and 5 days after injury and lasts anywhere between 12 h and 30 days [7, 10-13, 15, 16, 19-21].…”