Cerebral hemodynamic changes after wartime traumatic brain injury

Alexander Razumovsky*, Teodoro Tigno, Sven M. Hochheimer, Fred L. Stephens, Randy Bell, Alexander H. Vo, Meryl A. Severson, Scott A. Marshall, Stephen M. Oppenheimer, Robert Ecker, Rocco A. Armonda

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingConference contributionpeer-review

16 Scopus citations


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.

Original languageEnglish
Title of host publicationCerebral Vasospasm
Subtitle of host publicationNeurovascular Events After Subarachnoid Hemorrhage
PublisherSpringer-Verlag Wien
Number of pages4
ISBN (Print)9783709111918
StatePublished - 2013
Externally publishedYes

Publication series

NameActa Neurochirurgica, Supplementum
ISSN (Print)0065-1419
ISSN (Electronic)0001-6268


  • Cerebral blood flow velocity
  • Combat-associated wartime traumatic brain injury
  • Intracranial pressure
  • Transcranial Doppler ultrasonography
  • Vasospasm
  • Wartime traumatic brain injury


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