Abstract
Traumatic brain injury (TBI) is associated with the severest casualties from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). From October 1, 2008, the U.S. Army Medical Department initiated a transcranial Doppler (TCD) ultrasound service for TBI; included patients were retrospectively evaluated for TCD-determined incidence of post-traumatic cerebral vasospasm and intracranial hypertension after wartime TBI. Ninety patients were investigated with daily TCD studies and a comprehensive TCD protocol, and published diagnostic criteria for vasospasm and increased intracranial pressure (ICP) were applied. TCD signs of mild, moderate, and severe vasospasms were observed in 37%, 22%, and 12% of patients, respectively. TCD signs of intracranial hypertension were recorded in 62.2%; 5 patients (4.5%) underwent transluminal angioplasty for post-traumatic clinical vasospasm treatment, and 16 (14.4%) had cranioplasty. These findings demonstrate that cerebral arterial spasm and intracranial hypertension are frequent and significant complications of combat TBI; therefore, daily TCD monitoring is recommended for their recognition and subsequent management.
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Alexandrov AV, Sloan MA, Wong LKS, Douville C, Razumovsky AY, Koroshetz W, Kaps M, Tegeler CH, for the American Society of Neuroimaging Practice Guidelines Committee (2007) Practice standards for transcranial Doppler (TCD) ultrasound. Part I. Test performance. J Neuroimaging 17:11–18
Armonda RA, Bell R, Vo A, Ling G, DeGraba T, Ecklund J, Crandall B, Campbell WW (2006) Wartime traumatic cerebral vasospasm: recent review of combat casualties. Neurosurgery 59:1215–1225
Bell RS, Ecker RD, Severson MA III, Wanebo JE, Crandall B, Armonda RA (2010) The evolution of the treatment of traumatic cerebrovascular injury during wartime. A review. Neurosurg Focus 28(5):E5
Bellner J, Romner B, Reinstrup P, Kristiansson KA, Ryding E, Brandt L (2004) Transcranial Doppler sonography pulsatility index (PI) reflects intracranial pressure (ICP). Surg Neurol 62:45–51
Bor-Seng-Shu E, Hirsch R, Teixeira MJ, De Andrade AF, Marino R Jr (2006) Cerebral hemodynamic changes gauged by transcranial Doppler ultrasonography in patients with posttraumatic brain swelling treated by surgical decompression. J Neurosurg 104:93–100
Bouzat P, Francony G, Declety P, Genty C, Kaddour A, Bessou P, Brun J, Jacquot C, Chabardes S, Bosson JL, Payen JF (2011) Transcranial Doppler to screen on admission patients with mild to moderate traumatic brain injury. Neurosurgery 68:1603–1609
Bullock PM, Patterson J, Hadley P, Wiper DJ, Teasdale GM (1996) Focal cerebral hyperemia after focal head injury: a benign phenomenon? J Neurosurg 83:277–284
Cloft HJ, Joseph GJ, Dion JE (1999) Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation: a meta-analysis. Stroke 30:317–320
Diringer MN, Axelrod Y (2007) Hemodynamic manipulation in the neuro-intensive care unit: cerebral perfusion pressure therapy in head injury and hemodynamic augmentation for cerebral vasospasm. Curr Opin Crit Care 13:156–162
Diringer MN, Bleck TP, Hemphill JC III, Menon D, Shutter L, Vespa P, Bruder N, Connolly ES Jr, Citerio G, Gress D, Hänggi D, Hoh BL, Lanzino G, Le Roux P, Rabinstein A, Schmutzhard E, Stocchetti N, Suarez JI, Treggiari M, Tseng M-Y, Vergouwen MDI, Wolf S, Zipfel G (2011) Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference. Neurocrit Care 15:211–240
Dorsch N (2011) A clinical review of cerebral vasospasm and delayed ischaemia following aneurysm rupture. Acta Neurochir Suppl 110(Pt 1):5–6
Gura M, Elmaci I, Sari R, Coskun N (2011) Correlation of pulsatility index with intracranial pressure in traumatic brain injury. Turk Neurosurg 21:210–215
Kassell NF, Peerless SJ, Durward QJ, Beck DW, Drake CG, Adams HP (1982) Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension. Neurosurgery 11:337–343
Kincaid MS, Souter MJ, Treggiari MM, Yanez ND, Anne Moore A, Lam AM (2009) Accuracy of transcranial Doppler ultrasonography and single-photon emission computed tomography in the diagnosis of angiographically demonstrated cerebral vasospasm. J Neurosurg 110:67–72
Lindegaard KF, Nornes H, Bakke SJ, Sorteberg W, Nakstad P (1988) Cerebral vasospasm after subarachnoid haemorrhage investigated by means of transcranial Doppler ultrasound. Acta Neurochir Suppl 42:81–84
Ling G, Bandak F, Armonda R, Grant G, Ecklund J (2009) Explosive blast neurotrauma. J Neurotrauma 26(6):815–825
Melo JR, Di Rocco F, Blanot S, Cuttaree H, Sainte-Rose C, Oliveira-Filho J, Zerah M, Meyer PG (2011) Transcranial Doppler can predict intracranial hypertension in children with severe traumatic brain injuries. Childs Nerv Syst 27:979–984
Obrist WD, Langfitt TW, Jaqqi JL, Cruz J, Gennarelli T (1984) Cerebral blood flow and metabolism in comatose patients with acute head injury. Relationship to intracranial hypertension. J Neurosurg 61:241–253
Oertel M, Boscardin WJ, Obrist WD, Glenn TC, McArthur DL, Gravori T, Lee JH, Martin NA (2005) Posttraumatic vasospasm: the epidemiology, severity, and time course of an underestimated phenomenon: a prospective study performed in 299 patients. J Neurosurg 103:812–824
Sloan MA, Rigamonti D, Wozniak MA, Aldrich EF, Acosta JA, Shotts P, Jones D, Macko RF (1994) Prevalence of anterior circulation vasospasm: a transcranial Doppler study. Stroke 25:744
Washington CW, Zipfel GJ, The Participants in the International Multi-Disciplinary Consensus Conference on the Critical Care management of Subarachnoid Hemorrhage (2011) Detection and monitoring of vasospasm and delayed cerebral ischemia: a review and assessment of the literature. Neurocrit Care 15:312–317
Acknowledgements
This chapter was supported in part by the U.S. Army Medical Research and Material Command’s Telemedicine and Advanced Technology Research Center (Fort Detrick, MD, USA). In addition, we would like to express our gratitude to Richard L. Skolasky, Jr., assistant professor, director of the Spine Outcomes Research Center at Johns Hopkins University (Baltimore, MD, USA), for his statistical assistance and guidance. Also, we need to thank neurosonographers A. Dzhanashvili and Mirkko Galdo, who were responsible for data collection.
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We declare that we have no conflict of interest.
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Razumovsky, A. et al. (2013). Cerebral Hemodynamic Changes After Wartime Traumatic Brain Injury. In: Zuccarello, M., Clark, J., Pyne-Geithman, G., Andaluz, N., Hartings, J., Adeoye, O. (eds) Cerebral Vasospasm: Neurovascular Events After Subarachnoid Hemorrhage. Acta Neurochirurgica Supplement, vol 115. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1192-5_19
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