Myocardial Dysfunction in Acute Traumatic Brain Injury Relieved by Surgical Decompression

Vijay Krishnamoorthy,Sumidtra Prathep,Deepak Sharma,Monica S. Vavilala

doi:10.1155/2013/482596

Vijay Krishnamoorthy, Sumidtra Prathep + Show 2 more

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https://doi.org/10.1155/2013/482596

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Abstract

Traumatic brain injury (TBI) is a major public health issue and is a leading cause of death in North America. After a primary TBI, secondary brain insults can predispose patients to a worse outcome. One of the earliest secondary insults encountered during the perioperative period is hypotension, which has been directly linked to both mortality and poor disposition after TBI. Despite this, it has been shown that hypotension commonly occurs during surgery for TBI. We present a case of intraoperative hypotension during surgery for TBI, where the use of transthoracic echocardiography had significant diagnostic and therapeutic implications for the management of our patient. We then discuss the issue of cardiac dysfunction after brain injury and the implications that echocardiography may have in the management of this vulnerable patient population.

Highlights

Traumatic brain injury (TBI) is a major public health issue and is a leading cause of death in North America [1]
One of the earliest secondary insults encountered during the perioperative period is hypotension, which has been directly linked to both mortality and poor disposition after TBI [4, 5]
While recommendations of the 2007 Brain Trauma Foundation recommend maintaining systolic blood pressure (SBP) >90 mmHg [6], it has recently been shown that reduction in SBP to values below 90 mmHg commonly occurs during surgery for TBI

Summary

Introduction

Traumatic brain injury (TBI) is a major public health issue and is a leading cause of death in North America [1]. After a primary TBI, the burden of secondary brain insults can predispose patients to a worse outcome than if secondary insults did not occur [2, 3]. Therapy for intraoperative hypotension has traditionally consisted of the administration of intravenous fluids and vasopressors, and vasopressor choice in this setting is often empiric. The echocardiographic abnormalities were rapidly reversed after craniotomy and surgical decompression. In this case, the use of point of care (POC) intraoperative transthoracic echocardiography (TTE) allowed for timely identification of a cardiac cause of hypotension, and it facilitated appropriate vasopressor choice for treatment. The phenomenon of reversible cardiac dysfunction after traumatic intracranial hemorrhage, relieved by decompression, is postulated. IRB approval was not required for submission of this case

Case Presentation

Discussion