Posttraumatic Acute Diffuse Brain Swelling Research Articles

Logistic regression analysis of risk factors relevant to posttraumatic acute diffuse brain swelling

Logistic regression analysis of risk factors relevant to posttraumatic acute diffuse brain swelling

Combination effects of invasive intracranial pressure and transcranial Doppler monitoring in treatment of posttraumatic acute diffuse brain swelling

Objective To investigate the combined effects of invasive intracranial pressure and transcranial Doppler (TCD) monitoring in the treatment for posttraumatic acute diffuse brain swelling (PADBS). Methods The clinical data of 120 patients with PADBS admitted from January 2014 to January 2016 were retrospectively analyzed by case-control study. There were 88 males and 32 females, aged 19-70 years (mean, 43.6 years). Patients were divided into three groups based on whether they had accepted invasive intracranial pressure and TCD: Group A (37 cases) with neither invasive intracranial pressure nor TCD, Group B (40 cases) with invasive intracranial pressure only, and Group C (43 cases) with both intracranial pressure and TCD. The hospitalization time in ICU, better prognosis [Glasgow outcome scale (GOS) scored 4-5] at 12 months after injury, Barthel index (BI), and mini-mental status examination (MMSE), mydriasis rate, and decreased values of Glasgow coma scale (GCS) were compared among three groups. Results (1) The ICU length of stay in the Groups of A, B and C was respective (9.6±6.8)days, (9.2±5.4)days and (8.9±5.7)days (P>0.05). The ratio of better prognosis in the Groups of A, B and C was respective 46%(17/37), 65%(26/40) and 72%(31/43), showing a better result in Groups B and C than Group A (P 0.05). The BI in the Groups of A, B and C was respective (51.0±36.7)points, (58.0±35.7)points and (70.2±34.6)points, while the MMSE was respective(17.3±12.5)points, (18.8±12.0)points and (21.2±11.4)points. Both BI and MMSE in Groups B and C were higher than those in Group A (P 0.05). The decreased value of GCS from admission to initiation of operation in Groups A, B and C was (1.4±1.3)points, (0.7±0.5)points and (0.6±0.4)points respectively, showing a larger decrease in Group A than Groups B and C (P 0.05). Conclusion Application of invasive intracranial pressure and TCD monitoring can present a timely and precise condition changes, improve the better prognosis rate, daily activity abilities and cognitive function, indicating that it has protective effects on the brain function. Key words: Brain injuries; Intracranial pressure; Prognosis

Early stage alterations of catecholamine and adrenocorticotropic hormone levels in posttraumatic acute diffuse brain swelling.

Posttraumatic acute diffuse brain swelling (PADBS) is characterized by serious brain bulk enlargement rapidly following trauma and is a major cause of elevated intracranial pressure and thus mortality. The pathogenesis of PADBS is not clearly understood, and the early stage alterations of catecholamine (CA) and adrenocorticotropic hormone (ACTH) levels in PADBS also remain largely unknown. The objective of this study was to investigate CA and ACTH levels in the patients with PADBS in the early stage and discuss the possible roles CA and ACTH in the pathogenesis of PADBS. It is a cross-sectional study. A group of patients with PADBS (n=10) was compared with a group of patients with severe brain injury (SBI) (n=33). A control group of healthy adults (n=25) was also included. Blood samples were obtained to measure levels of epinephrine (EPI), norepinephrine (NE), dopamine (DA), and ACTH as soon as the patients arrived at the neurosurgery department, which was done within 4h after trauma. Both SBI and PADBS groups of patients had higher levels of EPI, NE, DA, and ACTH than the control group. The PADBS group had significantly higher levels of EPI, NE, and ACTH than the SBI group. CA and ACTH levels are significantly increased in early stage PADBS. These results imply that CA and ACTH may play important roles in the pathogenesis of PADBS. To eliminate the effects of CA and ACTH at the early stage, and thereby protect the hypothalamus and brain stem, might be critical measures for treating patients with PADBS.

Establishment of posttraumatic acute diffuse brain swelling with sinus balloon compression method in rabbits

Objective To establish a rabbit posttraumatic acute diffuse brain swelling (PADBS) model and investigate the mechanism of action. Methods Fifty New Zealand rabbits were assigned to control group (n=10) and model group (n=40) according to random number table. The animal model of sinus balloon compression was established under intracranial pressure monitoring by using intracranial pressure probe. The model group was subdivided equally at 1.5 hours after compression, 1.5 hours after decompression, 3 hours after decompression and 4.5 hours after decompression, for which intracranial pressure, brain water content, pathological mechanism and ultrastructure were measured dynamically. Results The success rate of modeling was 83%(33/40). Intracranial pressure was (4.9±0.8)mmHg in control group, (50.1±4.3)mmHg in 1.5 hours after compression group, (45.2±1.7)mmHg in 1.5 hours after decompression group, (48.6±2.2)mmHg in 3 hours after decompression group, and (59.1±2.5)mmHg in 4.5 hours after decompression group (P<0.05). Brain water content was (75.0±0.6)% in control gorup, (76.7±0.8)% in 1.5 hours after compression group, (77.3±0.5)% in 1.5 hours after decompression group, (78.5±0.6)% in 3 hours after decompression group, and (79.4±0.7)% in 4.5 hours after decompression group (P<0.05). Vasogenic brain oedema was seen 1.5 hours after decompression. Cytotoxicity brain swelling generated with brain tissue destroyed 3 hours after decompression. The vicious cycle of high intracranial pressure and brain tissue destruction occurred 4.5 hours after decompression. Conclusion Under intracranial pressure probe monitoring, the rabbit model of PADBS by sinus balloon compression has stable pressure of the sinus balloon and has good reliability and repeatability, which provides a reliable evidence for further study on the possible mechanism and treatment methods of PADBS. Key words: Brain edema; Intracranial pressure; Models, animal

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.

Modified decompression craniotomy for treatment of extremely severe posttraumatic acute diffuse brain swelling

Objective To investigate the effect of modified decompression craniotomy (MDC) for treatment of extremely severe post-traumatic acute diffuse brain swelling (PADBS).Methods Forty-eight patients with PADBS out of which 31 underwent standard large trauma decompression craniotomy (SDC) and 17 MDC were analyzed retrospectively.Clinical data,cranial capacity compensation,postoperative complications,and Glasgow outcome scale (GOS) 6 months after operation were recorded and compared between the two groups.Results Increased cranial capacity compensatory value accounted for 8.2％ of the cranial capacity after MDC.Postoperative complications included rehemorrhage,intracranial infection,incisional hernia,epilepsy,cerebrospinal fluid leakage,and hydrocephalus and no statistical differences were observed between the two groups (P ＞ 0.05).Based on GOS,the outcome was good in 13 patients (42％),poor in 13 (42％),with 5 deaths (16％) in SDC group,while the outcome was good in 13 patients (76％),poor in 3 (18％),with 1 death (6％) in MDC group.The outcome in MDC group was better than that in SDC group (Z =2.318,P ＜ 0.05).Conclusion For patients with PADBS,MDC can improve the outcome and prognosis. Key words: Craniocerebral trauma; Brain edema; Decompression, surgical; Cranial compensatory volume

Clinical treatment analysis of 60 cases with no midline shift-severe craniocerebral trauma accompanied with post-traumatic acute diffuse brain swelling

Objective To investigate the clinical efficacy and treatment method for no midline shift-severe craniocerebral trauma accompanied with post-traumatic acute diffuse brain swelling (PADBS).Methods 60 PADBS patients were randomly divided into conservative treatment group and operation group,30 patients in each group.The operation group was treated with intracranial pressure monitoring by implantation of the probe and decompressive craniectomy,while the conservative treatment group received conservative treatment.The postoperative recovery was observed.Results The GCS scores of operation group postoperative 7d and 15d were (11.21 ± 2.24) and (12.88 ±2.31),which were obviously higher than (7.47 ± 1.51) and (8.19 ± 1.28) of the conservative treatment group (t =2.215,2.321,all P ＜ 0.05).Postoperative long-term follow-up results indicated that,according to GOS score,63.3％ patients in the operation group recovered well,which was significantly higher than 26.7％ in the conservative treatment group.While the percent of patients with coma or dead was 6.7％ and 10.0％ in the operation group,which were significantly lower than the conservative treatment group (x2 =15.721,4.172,3.84,all P ＜ 0.05).Conclusion In general,PADBS could not be cured easliy,the operation methods of using intracranial pressure monitoring and decompressive craniectomy based on conservative treatment could help to evaluate the trauma objectivly,detect the changes of disease earlier,treat in time and assess the prognosis accurately,all which would reduce the mortality. Key words: Craniocerebral trauma; Post-traumatic acute diffuse brain swelling; Intracranial pressure monitoring; Decompressive craniectomy

Risk factors for posttraumatic acute diffuse brain swelling

Objective To analyze the risk factors of posttraumatic acute diffuse brain swelling (PADBS),explore its pathogenesis,and provide the evidence of pre- hospital medical care and sequent treatment through the epidemiological survey.Method Gender,age,time from injured to enter to hospital,force position,aspiration,hypotension,history of hypertension,primary brainstem injury,united injury,the presence or absence of skull base fracture were recorded and analyzed in 54 PADBS patients ( study group) and 270 patients without PADBS.Results Primary brainstem injury,hypotension,force position,aspiration,and age were closely correlated with the occurrence of PADBS.Conclusions Primary brainstem injury,hypotension,force position,and aspiration are the risk factors for PADBS,and agedness is a protective factor for PADBS. Key words: Brain edema; Risk factors ; Pathogenesis

Effect of treatment with hyperoxic liquid on the champing functions of patients with Posttraumatic acute diffuse brain swelling

目的 探讨早期静脉输注高氧液对外伤后急性弥漫性脑肿胀患者运动功能的影响. 方法外伤后急性弥漫性脑肿胀病人112例,分为早期静脉输注高氧液组(58例)和对照组(54)例,于治疗前后分别评定Fugl-Meyer运动功能积分和格拉斯哥预后评分. 结果 Fugl-Meyer运动功能积分在早期静脉氧疗组较治疗前和常规治疗组显著升高(P＜0.05);伤后30d的格拉斯哥昏迷评分(Glasgow coma scales, GCS)为9.8,较对照组的6.6显著升高;治疗组预后与对照组相比有显著性差异(P ＜0.01).结论早期静脉氧疗可显著减轻脑组织的病损程度,显著改善外伤后急性弥漫性脑肿胀病人的意识状态及其肢体运动功能,降低死亡率。

Effect of treatment with hyperoxic liquid on the neuron-specific enolase of patients with posttraumatic acute diffuse brain swelling

目的 探讨早期静脉输注高氧液对外伤后急性弥漫性脑肿胀患者神经元特异性烯醇化酶的影响.方法纳入我院2000年1月至2003年1月住院的外伤后急性弥漫性脑肿胀患者112例,分为早期静脉输注高氧液组(58例)和对照组(54)例,于治疗前后行神经元特异性烯醇化酶(NSE)含量的测定,同时评定GCS评分的变化.结果经高氧液治疗,治疗组NSE明显降低,与对照组相比差异有显著意义(P＜0.01).结论早期静脉氧疗可显著减轻脑组织的病损程度,降低病死率。