Traumatic Brain Edema in the Pathogenesis of Post-traumatic Hydrocephalus
The subjects of this prospective study were 64 consecutively admitted severely head injured patients with Glasgow coma scale (GCS), scores of <8. In 25 surviving patients the rate of ventricular dilatation was estimated by Evans index (EI) one month after injury and compared with the volume of brain edema, measured by the volumetric edema index (VEI), on computerized tomography (CT) (16–22 HU) in the acute period. A repetitive 2 ml bolus injection method was used for calculating the viscoelastic parameters of the craniospinal system (CSS). This study showed that the rate of posttraumatic hydrocephalus, defined as an EI >0.3, correlated more with the volume of brain edema measured during post-trauma days 3–5 and did not significantly correlate with the VEI of the first 36 h post injury. Throughout the period of study the CSF resorption resistance (R) remained within the normal range (<10mmHg/ml per min). At 1 month after injury intracranial pressure (ICP), pressure volume index (PVI), and elastance (E) showed the increase of the volume buffering capacity of the CSS. These data support the view that post-traumatic hydrocephalus development is mainly caused by the atrophy of injured and edematous brain tissue. Thus, in such cases shunting procedures are not appropriate.
KeywordsHead injury Post-traumatic hydrocephalus Brain edema CSF dynamics
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