Consideration of the Intracranial Pressure Threshold Value for the Initiation of Traumatic Brain Injury Treatment: A Xenon CT and Perfusion CT Study

Honda, Masashi; Ichibayashi, Ryo; Suzuki, Go; Yokomuro, Hiroki; Seiki, Yoshikatsu; Sase, Sadanori; Kishi, Taichi

doi:10.1007/s12028-017-0432-5

Cited by 18 publications

(12 citation statements)

References 36 publications

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“…Multiple studies have documented perfusion defects seen in TBI patients in a variety of sites throughout the brain [36,52,53,54,55,56,57]. Abnormal perfusion has been identified in the context of cerebral edema, extra-axial collections, and intracranial hypertension [58,59], see Figure 5, Figure 6 and Figure 7. One study has suggested that PCT may be able to distinguish whether an area of hypodensity on noncontrast CT is necrotic or viable, something that is not possible on noncontrast CT alone [60].…”

Section: Advanced Diagnostic Imaging Techniques In Traumatic Brainmentioning

confidence: 99%

Neuroimaging of Traumatic Brain Injury

Douglas

Toffoli

et al. 2018

Medical Sciences

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The purpose of this article is to review conventional and advanced neuroimaging techniques performed in the setting of traumatic brain injury (TBI). The primary goal for the treatment of patients with suspected TBI is to prevent secondary injury. In the setting of a moderate to severe TBI, the most appropriate initial neuroimaging examination is a noncontrast head computed tomography (CT), which can reveal life-threatening injuries and direct emergent neurosurgical intervention. We will focus much of the article on advanced neuroimaging techniques including perfusion imaging and diffusion tensor imaging and discuss their potentials and challenges. We believe that advanced neuroimaging techniques may improve the accuracy of diagnosis of TBI and improve management of TBI.

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Section: Advanced Diagnostic Imaging Techniques In Traumatic Brainmentioning

confidence: 99%

Neuroimaging of Traumatic Brain Injury

Douglas

Toffoli

et al. 2018

Medical Sciences

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“…It has a well-established role in the management of strokes and guides decisions on thrombolytic therapy by defining the area of ischaemic penumbra [ 5 , 6 , 7 , 8 ]. In studies in STBI patients, ICH has been associated with lower cerebral blood flow on CTP [ 9 ]. Abnormalities on CTP have also been shown to correlate with abnormalities in CPP and loss of cerebral autoregulation [ 10 , 11 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Abnormalities on Perfusion CT and Intervention for Intracranial Hypertension in Severe Traumatic Brain Injury

Cooper

Bendinelli

Bivard

et al. 2020

JCM

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The role of invasive intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (STBI) remain unclear. Perfusion computed tomography (CTP) provides crucial information about the cerebral perfusion status in these patients. We hypothesised that CTP abnormalities would be associated with the severity of intracranial hypertension (ICH). To investigate this hypothesis, twenty-eight patients with STBI and ICP monitors were investigated with CTP within 48 h from admission. Treating teams were blind to these results. Patients were divided into five groups based on increasing intervention required to control ICH and were compared. Group I required no intervention above routine sedation, group II required a single first tier intervention, group III required multiple different first-tier interventions, group IV required second-tier medical therapy and group V required second-tier surgical therapy. Analysis of the results showed demographics and injury severity did not differ among groups. In group I no patients showed CTP abnormality, while patients in all other groups had abnormal CTP (p = 0.003). Severe ischaemia observed on CTP was associated with increasing intervention for ICH. This study, although limited by small sample size, suggests that CTP abnormalities are associated with the need to intervene for ICH. Larger scale assessment of our results is warranted to potentially avoid unnecessary invasive procedures in head injury patients.

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“…When a patient with hemorrhagic stroke or TBI presents at a hospital emergency room, the clinician's priority is to forestall secondary tissue injury by preventing the immediate threats of systemic hypotension, hypoxia, and hypercarbia and by reducing the excess intracranial pressure. 112 In humans with hemorrhagic stroke or TBI, reducing intracranial pressure to levels at or below 20 mm Hg 34 is used as a proxy indicator for maintaining cerebral perfusion and oxygenation. 112 As reported previously, 25 immediate care for TBI is highly variable depending on the severity of the injury but also revolves around clinical management of intracranial pressure.…”

Section: Neurologic Injurymentioning

confidence: 99%

Defining and Managing Pain in Stroke and Traumatic Brain Injury Research

2019

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Neurologic conditions such as stroke and traumatic brain injury are challenging conditions to study in humans. Animal models are necessary to uncover disease processes and develop novel therapies. When attempting to model these or other neurologic diseases, the accompanying anesthesia and analgesia create variables that are not part of the onset of the clinical disease in the human population but are critical components of the postinjury care both in humans and animals. To maximize model validity, researchers must consider whether the disease process or a novel therapy is being studied. Damage to the neurons of the brain or the spinal cord is not painful at the neural tissue itself, but alterations to nociceptive signaling along the pain pathway can induce chronic pain. In addition, trauma or surgery leading to the event is associated with damage to peripheral tissue. Inflammation is inextricably associated with tissue injury. Inflammation is known to evoke nociception in the periphery and drive long-term changes to neurons in the CNS. Analgesics and anesthetics alter these responses yet are required as part of humane animal care. Careful planning for effective drug administration consistent with the standard of care for humans and equivalent animal care is required.

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Consideration of the Intracranial Pressure Threshold Value for the Initiation of Traumatic Brain Injury Treatment: A Xenon CT and Perfusion CT Study

Cited by 18 publications

References 36 publications

Neuroimaging of Traumatic Brain Injury

Neuroimaging of Traumatic Brain Injury

Abnormalities on Perfusion CT and Intervention for Intracranial Hypertension in Severe Traumatic Brain Injury

Defining and Managing Pain in Stroke and Traumatic Brain Injury Research

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