Advertisement

Hydrocephalus pp 311-323 | Cite as

Traumatic Brain Edema in the Pathogenesis of Post-traumatic Hydrocephalus

  • J. Tjuvajev
  • J. Eelmäe
  • T. Tomberg
  • A. Tikk

Summary

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.

Keywords

Head injury Post-traumatic hydrocephalus Brain edema CSF dynamics 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Adams J, Mitchell D, Graham D (1977) Diffuse brain damage of immediate type. Brain 100: 489–502PubMedCrossRefGoogle Scholar
  2. Alberico A, Ward J, Choi S, Marmarou A, Young H (1987) Outcome after severe head injury. J Neurosurg 67: 648–656PubMedCrossRefGoogle Scholar
  3. Auer L (1979) Long term monitoring of ventricular fluid pressure in patients with head injury problems and indications. Neurosurg Rev 2: 73–77CrossRefGoogle Scholar
  4. Blumbergs P, Jones N, North J (1989) Diffuse axonal injury in head trauma. J Neurol Neurosurg Psychiatry 52: 838–841PubMedCrossRefGoogle Scholar
  5. Borgesen S, Gjerris F, Sorensen S (1979) Intracranial pressure and conductance to outflow of CSF in normal pressure hydrocephalus. J Neurosurg 50: 489–493PubMedCrossRefGoogle Scholar
  6. Borgesen S, Gjerris F (1987) Relationships between intracranial pressure, ventricular size, and resistance to CSF outflow. J Neurosurg 67: 535–539PubMedCrossRefGoogle Scholar
  7. Busch G (1989) Post-traumatic defects in computed tomography. Neurosurg Rev 10: 269–273CrossRefGoogle Scholar
  8. Buschke H, Fuld P (1974) Evaluating storage, retention, and retrieval in disordered memory and learning. Neurology (NY) 24: 1019–1025Google Scholar
  9. Cao M, Lisheng H, Shouzheng S (1984) Resolution of brain edema in severe brain injury at controlled high and low intracranial pressures. J Neurosurg61: 707–712PubMedCrossRefGoogle Scholar
  10. Cullum C, Bigler E (1986) Late effects of hematoma on brain morphology and memory in closed head injury. Int J Neurosci 28: 279–283CrossRefGoogle Scholar
  11. Dikmen S, Temkin N, McLean A, Wyler A, Machamer J (1987) Memory and head injury severity. J Neurol Neurosurg Psychiatry 50: 1613–1618PubMedCrossRefGoogle Scholar
  12. Evans W (1942) An encephalometric ratio for estimating ventricular enlargement and cerebral atrophy. Arch Neurol Psych 47: 931–937Google Scholar
  13. Foroglou G (1976) L’Hydrocephalie post-traumatique. Neurochirurgie 22: 108–111PubMedGoogle Scholar
  14. French B, Dublin A (1977) The value of computerized tomography in the management of 1000 consecutive head injuries. Surg Neurol 7: 171–183PubMedGoogle Scholar
  15. Gradeur D, Allai R, Pidelievre C (1979) Etude tomodensitometrique des lesions cerebrales post-traumatiques. J Radiol 60: 79–86Google Scholar
  16. Groswasser Z, Cohen M, Reider-Groswasser I, Stern M (1988) Incidence, CT findings and rehabilitation out-come of patients with communicative hydrocephalus following severe head injury. Brain Inj 2: 267–272PubMedCrossRefGoogle Scholar
  17. Gudeman S, Kishore P, Becker D, Lipper M, Girevendulis A, Jeffries B (1981) Computed tomography in the evaluation of post-traumatic hydrocephalus. Radiology 141: 397–402PubMedGoogle Scholar
  18. Hannay H, Levin H, Grossman R (1979) Impaired recognition memory after head injury. Cortex 15: 269–283PubMedGoogle Scholar
  19. Hase U, Reulen H, Fenske A (1978) Intracranial pressure-volume in patients with subarachnoid hemorrhage (SAH). Acta Neurochir (Wien) 44: 69–80CrossRefGoogle Scholar
  20. Jane J, Stewart O, Genarelli T (1985) Axonal degeneration induced by experimental noninvasive minor head injury. J Neurosurg 62: 96–100PubMedCrossRefGoogle Scholar
  21. Jensen F, Jensen FM (1979) Acquired hydrocephalus. Acta Neurochir (Wien) 46: 243–257CrossRefGoogle Scholar
  22. Kaas B, Lonnum A (1978) Long-term prognosis of patients with central cerebral ventricular enlargement: A fifth follow-up study of 100 patients with third ventricle measuring 12 mm or more in width. Acta Neurol Scand 57: 19–30CrossRefGoogle Scholar
  23. Kishore P, Lipper M, Miller J (1978) Posttraumatic hydrocephalus in patients with severe head injury. Neuroradiology 16: 261–265PubMedCrossRefGoogle Scholar
  24. Koo A, LaRoge R (1977) Evaluation of head trauma by computed tomography. Radiology 123: 345–346PubMedGoogle Scholar
  25. Kobrine A, Kempe L (1973) Studies in head injury — Part 1.: An experimental model of closed head injury. Surg Neurol 1: 34–37PubMedGoogle Scholar
  26. Kosteljanez M (1986) CSF dynamics and pressure-volume relationships in communicating hydrocephalus. J Neurosurg 64: 45–52CrossRefGoogle Scholar
  27. Kosteljanez M, Ingstrup H (1985) Normal pressure hydrocephalus: Correlation between CT and measurements of cerebrospinal fluid dynamics. Acta Neurochir (Wien) 77: 8–13CrossRefGoogle Scholar
  28. Laws E, Mokri B (1977) Occult hydrocephalus: Results of shunting correlated with diagnostic tests. Clin Neurosurg 24: 316–333PubMedGoogle Scholar
  29. Levin H, Meyers C, Grossman R, Sarwar M (1981) Ventricular enlargement after closed head injury. Arch Neurol 38: 623–629PubMedCrossRefGoogle Scholar
  30. Levin H, Handel S, Goldman A, Eisenberg H, Guinto F (1985) Magnetic resonance imaging after ‘diffuse’ nonmissile head injury. Arch Neurol42: 963–968PubMedCrossRefGoogle Scholar
  31. Lewin W (1968) Preliminary observations on external hydrocephalus after severe head injury. Br J Surg 55: 747–751PubMedCrossRefGoogle Scholar
  32. Marmarou A, Shulman K, Rosende R (1978) A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics. J Neurosurg 48: 332–344PubMedCrossRefGoogle Scholar
  33. Marmarou A, Maset A, Ward J, Choi S, Brooks D, Lutz H, Moulton R, Muizellaar P, DeSales A, Young H (1987) Contribution of CSF and vascular factors to elevation of ICP in severely head-injured patients. J Neurosurg 66: 883–890PubMedCrossRefGoogle Scholar
  34. Maset A, Marmarou A, Ward J, Choi S, Lutz H, Brooks D, Moulton R, DeSales A, Muizellaar P, Turner H, Young H (1987) Pressure-volume index in head injury. J Neurosurg 67: 832–840PubMedCrossRefGoogle Scholar
  35. Meyers C, Levin H, Eisenberg H (1983) Early versus late ventricular enlargement following closed head injury. J Neurol Neurosurg Psychiatry 46: 1092–1097PubMedCrossRefGoogle Scholar
  36. Pedersen H, Gyldensted M, Gyldensted C (1979) Measuring normal ventricular system and supratentorial subarachnoidal spaces in children with computer tomography. Neuroradiology 17: 231–237PubMedCrossRefGoogle Scholar
  37. Pilz P (1983) Axonal injury in head injury. Acta Neurochir [Suppl] (Wien) 32: 119–123Google Scholar
  38. Reulen H, Tsuyumu M, Prioleau G (1980) Further results concerning the resolution of vasogenic brain edema. In: Vlieger M, Lange S, Becks J (eds) Brain edema: Pathology, diagnosis and therapy. Adv Neurol 28: 375–381Google Scholar
  39. Salmon J (1972) Adult hydrocephalus. Evaluation of shunt therapy in 80 patients. J Neurosurg 37: 423–428Google Scholar
  40. Strich S (1956) Diffuse degeneration of nerve fibres as a cause of brain damage due to head injury. A pathological study of twenty cases. J Neurol Neurosurg Psychiatry 19: 163–185PubMedCrossRefGoogle Scholar
  41. Symon L, Hinzpeter T (1977) The engima of normal pressure hydrocephalus: tests to select patients for surgery and predict shunt function. Clin Neurosurg 24: 285–315PubMedGoogle Scholar
  42. Tans J (1979) Differentiation of normal pressure hydrocephalus and cerebral atrophy by CT and spinal infusion test. J Neurol 222: 109–118PubMedCrossRefGoogle Scholar
  43. Tans J, Poortvliet D (1984) Comparison of ventricular steady-state infusion with bolus infusion and pressure recording for differentiation between arrested and nonarrested hydrocephalus. Acta Neurochir (Wien) 72: 15–29CrossRefGoogle Scholar
  44. Teasdale G, Jennett B (1974) Assessment of coma and impaired consiousness: A practical scale. Lancet II: 81–84CrossRefGoogle Scholar
  45. Tikk A, Eelmae J (1985) CSF hydrodynamics studied by means of a simple constant volume injection technique. In: Abstracts of the 6th International Symposium on Intracranial Pressure and Mechanisms of Brain Damage. June 9–13, Glasgow, Scotland, pp 10-11Google Scholar
  46. Van Dogen K, Braakman R (1980) Late computed tomography in survivors of severe head injury. Neurosurgery 7: 14–22CrossRefGoogle Scholar
  47. Wieser H, Probst C (1975) Clinical observations on hydrocephalus with special regard to the post-traumatic malresorptive form. J Neurol 212: 1–21CrossRefGoogle Scholar
  48. Wilson J, Wiedmann K, Hadley D, Condon B, Teasdale G, Brooks D (1988) Early and late magnetic resonance imaging and neuropsychological outcome after head injury. J Neurol Neurosurg Psychiatry 51: 391–396PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 1991

Authors and Affiliations

  • J. Tjuvajev
  • J. Eelmäe
  • T. Tomberg
  • A. Tikk
    • 1
  1. 1.Department of NeurosurgeryTartu University HospitalTartuEstonia

Personalised recommendations