Posttraumatic Diffuse Brain Swelling Research Articles

Changes in cerebral hemodynamics in patients with posttraumatic diffuse brain swelling after external intraventricular drainage

PurposeTo investigate the changes of cerebral hemodynamics pre- and post-ventricular drainage in patients with posttraumatic acute diffuse brain swelling. MethodsTwenty-four cases of traumatic diffuse brain swelling were analyzed retrospectively. Patients in nonsurgical group were treated by medicine therapy. Patients in surgical group were treated by external ventricular drainage plus medicine therapy. The first CT perfusion scan was completed within 4–5 h after trauma and scanned again after 7 days. The changes of perfusion parameters in area-of-interest in two groups were analyzed and compared before and after treatment. ResultsCompared with the nonsurgical group, the value of cerebral blood volume, cerebral blood flow and mean transit time in bilateral frontal temporoparietal grey matter, basal ganglia, cerebellum, and brain stem at pre- and post-therapy were increased significantly (p < 0.05) in surgical group, and consequently the prognosis of patients undergoing surgery was also better than that of nonsurgical group. ConclusionExternal ventricular drainage can improve cerebral perfusion and increase survival quality for the patients with posttraumatic acute diffuse brain swelling.

Clinical classification and treatment for posttraumatic acute brain swelling

Objective To investigate the clinical classification and the appropriate treatment strategies for posttraumatic acute diffuse brain swelling.Methods A retrospective study was performed in 45 patients with posttraumatic acute diffuse brain swelling who were confirmed on a CT scan,all of them were monitored intracranial pressure (ICP) after admission,and then determine the clinical classification and the corresponding treatment strategies in accordance with the initial ICP value,and compared the preoperative -postoperative ICP value of patients who underwent craniectomy through Two - sample t - test.Results Initial ICP value were greater than 35mmHg in 33 out of 45 patients,31 cases underwent craniectomy,one case was failed to surgery because of excessive high ICP,one case underwent conservative treatment because the ICP less than 30mmHg after giving bolus intravenous infusions of mannitol.33 patients had different outcome including 18 cases who died,three remained in a vegetative state,two with severe deficits,one with moderate deficits,eight with a good recovery ; 6 cases ( ICP ＞ 25 ～ 35 mmHg) had different outcome including one with vegetative state,one with severe deficits,four with a good recovery,3 of them underwent craniectomy; 6 cases (ICP15 ～25 mmHg) had different outcome including one with vegetative state,five with a good recovery,all of them underwent conservative treatment.Conclusions It can be divided into three types for posttraumatic diffuse brain swelling in accordance with the initial ICP value including severe intracranial hypertension type ( ICP ＞ 35 mmHg) ; moderate intracranial hypertension type ( ICP ＞ 25 ～ 35 mmHg) ; mild intracranial hypertension type (ICP15 ～25 mmHg) ; Early ICP monitoring has a positive effect to determine the treatment of patients with posttraumatic acute brain swelling. Key words: Posttraumatic diffuse brain swelling; Clinical classification; Intracranial pressure; Surgical procedures,operative

Treatment strategy of bilateral frontal lobe contusion and laceration with central herniation

Objective To study the clinical features of the bilateral frontal brain contusion with cerebral hernia center and its treatment strategies. Methods The clinical data of 76 patients with cerebral central hernia were restropectively analyzed. Results In 76 patients,there were 53 cases survive,23 cases died.The life and survival quality of these patients were evaluated according to the Karnofsky scale systerm :46 patients underwent surgery,including 35 cases with good recovery,8 cases with long-term coma or unable to look after themselves,3 cases with death;10 cases underwent a expectant treatment,of which,6 cases with good recovery,4 cases with long-term coma or unable to look after themselves.The other 20 cases died of central brain stem failure,with a central hernia when admissioned. Conclusion Patients with bilateral frontal brain contusion were extremely complicated with central hernia,and had a suddenly deteriored condition.Close observation of changes were critical importance.The surgery should be carried out before diencephalon period,for most recovery well after surgery.Patients with diffuse brain swelling should go under the depressioning surgery as earlier as possible. Key words: Contusion and laceration of bilateral frontal lobe; Central herniation; Posttraumatic diffuse brain swelling; Treatment

Continuous ventricular cerebrospinal fluid drainage with intracranial pressure monitoring for management of posttraumatic diffuse brain swelling

Ventricular drainage has played an important role in the management of traumatic brain-injured patients. The aim of the present study was describe outcomes in a series of 57 patients with diffuse brain swelling underwent to intracranial pressure (ICP) monitoring. Fifty-eight patients with diffuse posttraumatic brain swelling, were evaluated prospectively. The Glasgow Coma Scale (GCS) scores of patients varied from 4 to 12. Patients groups divided according to GCS and age. Patient neurological assessment was classified as favorable, unfavorable, and death. Mechanisms of injury were vehicle accidents in 72.4% and falls in 15.6%. 54% of patients had GCS scores between 6 and 8. There were no statistical differences, regarding outcome, between groups separated by age. In the adults group (n=47), 44.7% evolved favorably. Our results indicate a poor prognosis in patients with brain swelling. We believe that continuous ventricular CSF drainage with ICP monitoring is a simple method as an adjunct in the management of these patients.

Haemodynamic patterns in children with posttraumatic diffuse brain swelling. A preliminary study in 6 cases with neuroradiological features consistent with diffuse axonal injury

In the present report we describe the cerebral haemodynamics and the neuroradiological findings observed in six consecutive children, three males and three females aged 4-15.6 yrs (mean age 8.95) displaying a neuroradiological pattern consistent with diffuse axonal injury (DAI) along with slit ventricles. All the patients were admitted to the Paediatric Intensive Care Unit with GCS scores less than 8 after a severe brain injury. Serial head computed to mography (CT) and magnetic resonance (MR) scans demonstrated a radiological pattern of DAI. Transcranial Doppler Sonography (TCD) of the middle cerebral arteries was performed through the temporal bone window in all the patients. All patients but one underwent a continuous monitoring of intracranial pressure (ICP) and cerebral extraction of O(2) (CEO(2)). Treatment with barbiturates and hyperventilation was necessary in all the cases. In one patient, a bilateral decompressive cran iectomy was performed in order to decrease severe in tracranial hypertension. Hyperflow along with intracranial hyper tension, variably responsive to barbiturate medication, was observed in all the patients by means of TCD and CEO(2). Intracranial hypertension can be elevated in pediatric posttraumatic hyperflow syndromes associated with DAI. The observation of the time course of the parameters studied allowed us to modify the pharmacological treatment and/or perform surgical decompression (external cerebrospinal fluid (CSF) drainage in five cases; decompressive craniectomy in one case). Compartmental hyperflow TCD pattern was evident in only one patient. Although the limited number of pa tients in our series does not allow definite conclusions, we strongly believe that TCD, with ICP and CEO(2) monitoring, are useful tools in planning surgical strategy in children with neuroradiological signs of DAI.

Evaluation of cerebrovascular CO2-reactivity and autoregulation in patients with post-traumatic diffuse brain swelling (diffuse injury III).

The present study was undertaken to elucidate the status of autoregulation and CO2-reactivity soon after injury in patients with a post-traumatic diffuse bilateral brain swelling. A prospective study was carried out in 31 consecutively admitted patients with a severe head injury and a Diffuse Brain Injury type III, following the definition stated by the Traumatic Coma Data Bank classification. To evaluate CO2-reactivity, AVDO2 was measured before and after ventilator manipulations. Assuming a constant CMRO2 during the test, changes in 1/AVDO2 reflect changes in CBF. Patients with changes in estimated CBF below or equal to 1% were included in the impaired/abolished CO2-reactivity group. To test autoregulation, hypertension was induced using phenylephrine. Arterial and jugular blood samples were taken to calculate AVDO2 before and after a steady state of MABP was obtained. Cerebrovascular response to CO2 was globally preserved in all but two cases (6.5%). In contrast, autoregulation was globally preserved in 10 (32.3%) and impaired/abolished in 21 cases (67.7%). Our data do not support the premise that increasing cerebral perfusion pressure by inducing arterial hypertension is beneficial in those patients with a diffuse brain swelling in whom autoregulation is impaired or abolished. Clinical implications for treatment are discussed.

Post-traumatic diffuse brain swelling: isolated or associated with cerebral axonal injury. Clinical course and intracranial pressure in 18 children.

Eighteen children with severe head injuries and diffuse brain swelling were studied. They were separated into two groups based on the computed tomography (CT) findings. Seven patients had small ventricles in the normal location and small or absent cisterns. Eleven had these signs plus small deep-seated intraparenchymal hemorrhagic foci and/or intraventricular hemorrhage. Patients in the first group were in relatively good neurological condition; their intracranial pressure was easily controlled and all had a favourable outcome. On contrast, children in the second group had a more severe clinical presentation, frequently had uncontrollable intracranial hypertension, and more than 50% died.