Brain Failure pp 198-205 | Cite as

Cerebral Blood Flow in Head Injury

  • K. Gunning
  • A. Forster
Conference paper
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 9)

Abstract

For the past 10 years it has been possible to measure cerebral blood flow (CBF) at the bedside in head-injured patients. Many clinical studies have been performed which have improved our understanding of the pathophysiological processes that occur after a severe head injury. These studies are complex and summarized in Table 1. Care must be taken when comparing results from different centers, as head injured patients do not form a homogeneous group with regard to age, mechanism and severity of injury. Differences in technique or in timing of CBF measurement after the acute event must be taken into account as well as the effects of different therapeutic regimens. Severe head injuries rarely occur in isolation; shock and hypoxia due to concomitant multiple trauma will be superimposed on the initial damage caused by the head injury.

Keywords

Ischemia Lactate Dementia Pyruvate Bicarbonate 

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References

  1. 1.
    Obrist WD, Gennarelli TA, Segawa H, et al (1979) Relation of cerebral blood flow to neurological status and outcome in head-injured patients. J Neurosurg 51:292–300PubMedCrossRefGoogle Scholar
  2. 2.
    Bruce DA, Langfitt TW, Miller JD, et al (1973) Regional cerebral blood flow, intracranial pressure, and brain metabolism in comatose patients. J Neurosurg 38:131–144PubMedCrossRefGoogle Scholar
  3. 3.
    Fieschi C, Battistini N, Beduschi A, Boselli L, Rossanda M (1974) Regional cerebral blood flow and intraventricular pressure in acute head injuries. J Neurol Neurosurg Psychiatry 37:1378–1388PubMedCrossRefGoogle Scholar
  4. 4.
    Enevoldsen EM, Cold G, Jensen FT, et al (1976) Dynamic changes in regional CBF, intraventricular pressure, CSF pH and lactate levels during acute phase of head injury. J Neurosurg 44:191–214PubMedCrossRefGoogle Scholar
  5. 5.
    Overgaard J, Tweed WA (1974) Cerebral circulation after head injury. Part 1: cerebral blood flow and its regulation after closed head injury with emphasis on clinical correlations. J Neurosurg 41:531–541PubMedCrossRefGoogle Scholar
  6. 6.
    Obrist WD, Thompson HK Jr, Wang HS, et al (1975) Regional cerebral blood flow estimated by 133Xenon inhalation. Stroke 6:245–256PubMedCrossRefGoogle Scholar
  7. 7.
    Rappaport ZH, Ransohoff J, Hass WK (1981) Cerebral metabolism in head trauma. Prog Neurol Surg 10:1–13Google Scholar
  8. 8.
    Tabbador K, Bhushan C, Pevsner PH, et al (1972) Prognostic value of cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) in acute head trauma. J Trauma 12:1053–1055CrossRefGoogle Scholar
  9. 9.
    Obrist WD, Langfitt TW, Jaggi JL, Crutz J, Gennarelli TA (1984) Cerebral blood flow and metabolism in comatose patients with acute head injury. J Neurosurg 61:241–253PubMedCrossRefGoogle Scholar
  10. 10.
    Lassen NA (1966) The luxury-perfusion syndrome and its possible relation to acute metabolic acidosis localised within the brain. Lancet 2:1113–1115PubMedCrossRefGoogle Scholar
  11. 11.
    King LR, McLaurin RL, Knowles HC Jr (1974) Acid-base balance and arterial and CSF lactate levels following human head injury. J Neurosurg 40:617–625PubMedCrossRefGoogle Scholar
  12. 12.
    Cold GE, Enevoldsen E, Malmros R (1975) Ventricular fluid lactate, pyruvate, bicarbonate and pH in unconscious brain-injured patients subjected to controlled ventilation. Acta Neurol Scand 52:187–195PubMedCrossRefGoogle Scholar
  13. 13.
    Zupping R (1970) Cerebral acid-base gas metabolism in brain injury. J Neurosurg 33:498–505PubMedCrossRefGoogle Scholar
  14. 14.
    Cold GE (1986) The relationship between cerebral metabolic rate of oxygen and cerebral blood flow in the acute phase head injury. Acta Anaesthesiol Scand 30:453–457PubMedCrossRefGoogle Scholar
  15. 15.
    Cold GE, Jensen FT, Malmros R (1977) The cerebrovascular CO2 reactivity during the acute phase of brain injury. Acta Anaesthesiol Scand 21:222–231PubMedCrossRefGoogle Scholar
  16. 16.
    Cold GE, Jensen FT, Malmros R (1977) The effects of PaCO2 reduction on regional cerebral blood flow in the acute phase of brain injury. Acta Anaesthesiol Scand 21:359–369PubMedCrossRefGoogle Scholar
  17. 17.
    Cold GE (1978) Cerebral metabolic rate of oxygen (CMRO2) in the acute phase of brain injury. Acta Anaesthesiol Scand 22:249–256PubMedCrossRefGoogle Scholar
  18. 18.
    Obrist WD, Dolinskas CA, Gennarelli TA (1979) Relation of cerebral blood flow to CT scan in acute head injury. In: Popp AJ, Bourke RS, Nelson LR (eds) Neutral trauma. Raven Press, New York, pp 40–51Google Scholar
  19. 19.
    Overgaard J, Modsal C, Tweed WA (1981) Cerebral circulation after head injury. Part 3: Does regional cerebral blood flow determine recovery of brain function after blunt head injury? J Neurosurg 55:63–74PubMedCrossRefGoogle Scholar
  20. 20.
    Enevoldsen EM, Jensen FT (1978) Autoregulation and CO2 responses of cerebral blood flow in patients with acute severe head injury. J Neurosurg 48:689–703PubMedCrossRefGoogle Scholar
  21. 21.
    Enevoldsen EM, Jensen FT (1977) Compartmental analysis of regional cerebral blood flow in patients with acute severe head injuries. J Neurosurg 47:699–712PubMedCrossRefGoogle Scholar
  22. 22.
    Graham DI, Adams JH (1971) Ischaemic brain damage in fatal head injuries. Lancet 1:265–266PubMedCrossRefGoogle Scholar
  23. 23.
    Wei EP, Dietrich WD, Povlishock JT, Navari RM, Kontos HA (1980) Functional morphological and metabolic abnormalities of the cerebral microcirculation after concussive brain injury in cats. Circ Res 46:37–47PubMedGoogle Scholar
  24. 24.
    Kontos HA, Wei EP, Dietrich WP, et al (1981) Am J Physiol 244:H511–H527Google Scholar
  25. 25.
    Proctor HJ, Palladino GW, Fillipo D (1988) Failure of autoregulation after closed injury: an experimental model. J Trauma 28:347–352PubMedCrossRefGoogle Scholar
  26. 26.
    Langfitt TW, Weinstein JD, Kassell NF (1965) Cerebral vasomotor paralysis produced by intracranial hypertension. Neurology 15:622–641PubMedGoogle Scholar
  27. 27.
    Lewelt W, Jenkins LW, Miller JD (1980) Autoregulation of cerebral blood flow after experimental fluid percussion injury of the brain. J Neurosurg 53:500–511PubMedCrossRefGoogle Scholar
  28. 28.
    Uzell BP, Obrist WD, Dolinskas CA, Langfitt TW (1986) Relationship of acute CBF and ICP findings to neuropsychological outcome in severe head injury. J Neurosurg 65:630–635CrossRefGoogle Scholar
  29. 29.
    Messeter K, Nordström CH, Sundbärg G, Algotsson L, Ryding E (1986) Cerebral hemodynamics in patients with acute severe head trauma. J Neurosurg 64:231–237PubMedCrossRefGoogle Scholar
  30. 30.
    Nordström CH, Messeter K, Sundbärg G, Schalen W, Werner M, Ryding E (1988) Cerebral blood flow, vasoreactivity, and oxygen consumption during barbiturate therapy in severe traumatic brain lesions. J Neurosurg 68:424–431PubMedCrossRefGoogle Scholar
  31. 31.
    Muizelaar JP, Lutz HA, Becker DP (1984) Effect of mannitol on ICP and CBF and correlation with pressure autoregulation in severely head injured patients. J Neurosurg 61:700–706PubMedCrossRefGoogle Scholar
  32. 32.
    Mendelow AD, Teasdale GM, Russell T, Flood J, Patterson J, Murray GD (1985) Effect of mannitol on cerebral blood flow and cerebral perfusion pressure in human head injury. J Neurosurg 63:43–48PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1989

Authors and Affiliations

  • K. Gunning
  • A. Forster

There are no affiliations available

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