TY - GEN
T1 - Cerebral hemodynamic changes after wartime traumatic brain injury
AU - Razumovsky, Alexander
AU - Tigno, Teodoro
AU - Hochheimer, Sven M.
AU - Stephens, Fred L.
AU - Bell, Randy
AU - Vo, Alexander H.
AU - Severson, Meryl A.
AU - Marshall, Scott A.
AU - Oppenheimer, Stephen M.
AU - Ecker, Robert
AU - Armonda, Rocco A.
N1 - Funding Information:
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.
PY - 2013
Y1 - 2013
N2 - 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.
AB - 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.
KW - Cerebral blood flow velocity
KW - Combat-associated wartime traumatic brain injury
KW - Intracranial pressure
KW - Transcranial Doppler ultrasonography
KW - Vasospasm
KW - Wartime traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85052608682&partnerID=8YFLogxK
U2 - 10.1007/978-3-7091-1192-5_19
DO - 10.1007/978-3-7091-1192-5_19
M3 - Conference contribution
C2 - 22890651
AN - SCOPUS:85052608682
SN - 9783709111918
T3 - Acta Neurochirurgica, Supplementum
SP - 87
EP - 90
BT - Cerebral Vasospasm
PB - Springer-Verlag Wien
ER -