Cerebral Blood Flow in Traumatic Contusions Is Predominantly Reducedafter an Induced Acute Elevation of Cerebral Perfusion Pressure

Chieregato, Arturo; Tanfani, A.; Compagnone, Christian; Pascarella, Rosario; Targa, L.; Fainardi, Enrico

doi:10.1227/01.neu.0000249194.76527.28

Cited by 20 publications

(23 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The basis for a paradoxical response is uncertain, but could be due to elevated intracranial pressure (ICP), hemodynamic consequences of heart failure, or autonomic dysfunction. Similar paradoxical responses have been previously reported in traumatic brain injury [76]. Close examination of a recent work that used NIRS to monitor blood oxygen saturation during postural changes in acute stroke patients reveal a paradoxical response and large intra-subject variability in line with our results [30].…”

Section: Discussionsupporting

confidence: 92%

Transcranial optical monitoring of cerebrovascular hemodynamics in acute stroke patients

Durdurán¹,

Zhou²,

Edlow³

et al. 2009

Opt. Express

151

149

View full text Add to dashboard Cite

Abstract"Diffuse correlation spectroscopy" (DCS) is a technology for non-invasive transcranial measurement of cerebral blood flow (CBF) that can be hybridized with "near-infrared spectroscopy" (NIRS). Taken together these methods hold potential for monitoring hemodynamics in stroke patients. We explore the utility of DCS and NIRS to measure effects of head-of-bed (HOB) positioning at 30°, 15°, 0°, −5° and 0° angles in patients with acute ischemic stroke affecting frontal cortex and in controls. HOB positioning significantly altered CBF, oxy-hemoglobin (HbO 2 ) and total-hemoglobin (THC) concentrations. Moreover, the presence of an ipsilateral infarct was a significant effect for all parameters. Results are consistent with the notion of impaired CBF autoregulation in the infarcted hemisphere.

show abstract

Section: Discussionsupporting

confidence: 92%

Transcranial optical monitoring of cerebrovascular hemodynamics in acute stroke patients

Durdurán¹,

Zhou²,

Edlow³

et al. 2009

Opt. Express

151

149

View full text Add to dashboard Cite

show abstract

“…Regarding focal hypoperfusion, however, clinical studies by means of PET have shown only minor improvements in rCBF in intralesional edematous area following CPP elevation [123]. In a subsequent study [57], we showed that only intraparenchymal lesions with low critical rCBF within the intralesional edematous area can gain a minor improvement (Fig. 47).…”

Section: Fig (45)mentioning

confidence: 66%

“…These variables are normally used to evaluate meaningful responses to therapies. To our knowledge, only four kinds of tests have been applied by means of Xe-CT in TBI patients: induced hypocapnia [53][54][55], indomethacin bolus [56], norephinephrine-induced CPP elevation [57] and increase in FiO 2 from 0.35 to 0.6 [6].…”

Section: When Why and How An Xe-ct Study Should Be Performed?mentioning

confidence: 99%

A Practical Approach to Interpretation of CBF Measured by Mean of Xenon-CT in Patients with Traumatic Brain Injury~!2010-03-08~!2010-03-29~!2010-09-14~!

Chieregato¹

2010

TONEUROSJ

Self Cite

View full text Add to dashboard Cite

Abstract:The measurement of cerebral blood flow (CBF) in traumatic brain injury (TBI) by means of Xenon-CT (Xe-CT) has been part of the clinical practice of several centres since 1980. Xe-CT consists of a CBF image coupled with CT which offers the possibility to associate morphologic features given by CT with functional information. Today, Xe-CT, in association with Positron Emission Tomography (PET), represents the gold standard for clinical quantitative measurement of CBF. More recently, Xe-CT has improved its potential application in the intensive care unit by means of portable CT scanner. The aim of the present review is to describe the practical experience of a single center with over five hundred Xe-CT studies obtained in more than two hundred TBI patients, to provide a method to guide the lecture of images at bedside, to present illustrative cases and to review the literature published so far on Xe-CT and TBI. The physiological and clinical variables which may be useful to explain global and regional CBF are detailed. Global CBF and its relationship with ageing, the natural time course in TBI, and the dependency on physiological variables and therapy are discussed. The coupling of global CBF with cerebral metabolic rate of oxygen (CMRO2) and the relationship of arterial venous oxygen content differences (AVDO2) with patient outcome are analyzed. Finally, the current knowledge on regional CBF found in the most important traumatic lesions (posttraumatic cerebral infarction, contusion/laceration, acute subdural hematomas, and intraparenchymal hematoma) is described.Keywords: Arteriovenous difference of oxygen, cerebral blood flow, cerebral metabolic rate of oxygen, ischemia, outcome, traumatic brain injury, Xenon CT.

show abstract

“…This suggests that if one is considering placing a patient on vasopresor agents to maintain a certain CPP, it is important to know whether that patient even requires a potentially harmful drug. Furthermore, it has been shown, both in trauma [43] and in subarachnoid hemorrhage [44], that a paradoxical decrease in CBF can occur in some patients on vasoactive drugs, emphasizing the importance of measuring the individual tissue response to an intervention.…”

Section: Xenon/ct In Traumatic Brain Injurymentioning

confidence: 99%

“…Xenon/CT data shows that the pericontusional tissue around hematomas may have marginal perfusion, but are usually not truly ischemic, arguing that decompression of the ischemic hematoma with attention to preservation of surrounding tissue is the most rational approach to these lesions when surgery is indicated [43,[48][49][50]. The most appropriate medical therapy (particularly blood pressure/CPP) to ensure adequate CBF to the pericontusional tissue may also be assessed in this manner [43,50].…”

Section: Xenon/ct In Traumatic Brain Injurymentioning

confidence: 99%

Editorial - Neuromonitoring: The Concept of Targeted Therapy Revisited

Soustiel¹

2010

TONEUROSJ

View full text Add to dashboard Cite

Abstract:Xenon/CT provides quantitative CBF data that has a proven record of being both safe and prognostic for decision making. The technique itself has been extensively validated. Modern equipment has allowed for integration of the data into immediate bedside decision-making with the use of a portable head CT scanner and improved data processing. The use of xenon/CT in decision making in traumatic brain injury may have a high utility in determining whether a specific treatment-whether it is hyperventilation, induced hypertension, or other intervention-is in fact helpful to the individual patient. This can allow for decision making based on an individual patient's physiology rather than generalized guidelines which may, in some cases, even be harmful.

show abstract

Cerebral Blood Flow in Traumatic Contusions Is Predominantly Reducedafter an Induced Acute Elevation of Cerebral Perfusion Pressure

Cited by 20 publications

References 30 publications

Transcranial optical monitoring of cerebrovascular hemodynamics in acute stroke patients

Transcranial optical monitoring of cerebrovascular hemodynamics in acute stroke patients

A Practical Approach to Interpretation of CBF Measured by Mean of Xenon-CT in Patients with Traumatic Brain Injury~!2010-03-08~!2010-03-29~!2010-09-14~!

Editorial - Neuromonitoring: The Concept of Targeted Therapy Revisited

Contact Info

Product

Resources

About