Abstract
Brain trauma (BT) is extremely common in the Western society, and has been identified as the main cause of death and disability in the under-40 age group. Many aspects of the pathophysiological mechanisms involved and the effect of changes in cerebral metabolism are unclear. The aim of this study was to establish the rela- tionship between anatomical changes and deranged cerebral perfusion in patients with cerebral contusions, using Computed Tomography (CT) and Single Proton Emission Computed Tomography (SPECT). Twenty- two (22) patients who had suffered BT were recruited. All patients underwent SPECT and CT head scans on the same day. 18 were men. Patient average age was 45.6. Patients were assessed using the Glasgow scale (average 10.6). Cause of trauma included traffic accidents (9 patients) and falls (13 patients). A 4-slice spiral CT scan was performed. For each contusion, areas of bleeding, edema, and healthy perilesional tissue were distinguished. SPECT was performed with 20 mCi of 99 mTcECD using a dual-head gamma camera (128 × 128 matrix). CT scan revealed a single lesion in 12 patients, and more than one lesion in 10. The biggest le- sions found on CT were located in the frontal region in 13 patients; temporal region in 4; and parietal region in 1; four patients had poorly defined lesions. A total absence of perfusion was visible in 18 patients in the hemorrhagic area and in 14 patients in the edema, In 7 cases SPECT showed hypoperfusion that did not cor- respond to any morphological changes on the CT scan. Quantitative of fused lesions appearing on both CT scan and SPECT revealed severe perfusion defects in the hemorrhagic area (17.8%) and in the edema (29.4%). In our study, regional cerebral blood flow add relevant information on encephalic damage in pa- tients with BT.
Highlights
Brain trauma (BT) has been called the silent epidemic of the 21st century
The aim of our study was to determine the relationship between different neuroimaging patterns, Single Proton Emission Computed Tomography (SPECT) and Computed Tomography (CT), in assessing the extent and severity of cerebral perfusion changes in cerebral contusions seen in patients with HI and determining the viability of involved brain tissue
Between January 2005 and September 2006, a prospective assessment was done of a total of 22 consecutive patients (6 women) average age 45.6 who were admitted to the Neurotraumatology Service of our hospital following BT
Summary
The incidence in Western countries is 200 - 400 in every 100,000 inhabitants/year, and HI (Head Injury) are the foremost cause of death and disability in the under 40 age group [1,2]. The findings of a number of multicenter studies performed in recent years have shown that mortality rates in general hospitals are high, generally ranging between 30% and 40%. When metabolic derangements arising from BT are interpreted it is difficult to determine the extent and severity of ischemia and cell necrosis and the significance of the edema [5,6]. Brain trauma (BT) is defined as a physical lesion or functional deterioration of cranial content owing to an abrupt mechanical energy exchange [7]. Cerebral contusions are focal lesions in which there are delimited areas of bleeding, edema, tissue necrosis and destruction of the central nervous system. The severity of the biomechanical impact is important from the standpoint of survival and functional outcome, systemic or intracranial aggressions that appear minutes, hours or days after ac-
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