rCBF in Hemorrhagic, Non-Hemorrhagic and Mixed Contusions After Severe Head Injury and its Effect on Perilesional Cerebral Blood Flow

Hoelper, B. M.; Reinert, Michael; Zauner, Alois; Bullock, Ross

doi:10.1007/978-3-7091-6346-7_5

Cited by 15 publications

(14 citation statements)

References 16 publications

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“…According to previous authors (Schroder et al, 1995;McLaughlin et Marion, 1996;Hoelper et al, 2000), a value of CBF below 18 mL/100 g/min (Jones et al, 1981) was used to dichotomize the rCBF measurements.…”

Section: Discussionmentioning

confidence: 99%

“…Microscopic findings of cytotoxic edema and microvascular ischemia (Schröder et al, 1995) were also found in this area. While the role of ischemia in contusional areas remains controversial (Schröder et al, 1995;McLaughlin and Marion, 1996;Hoelper et al, 2000;von Oettingen et al, 2002;Furuya et al, 2003), it has been reported that the contusional rCBF may improve from the center to the periphery (von Oettingen et al, 2002, Steiner et al, 2003. Considering that also the different types of edema are distributed concentrically , it seems reasonable to hypothesize an interaction between brain edema and the distribution of the rCBF disturbances.…”

Section: Introductionmentioning

confidence: 93%

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Centrifugal Distribution of Regional Cerebral Blood Flow and its Time Course in Traumatic Intracerebral Hematomas

Chieregato

Fainardi²,

Servadei³

et al. 2004

Journal of Neurotrauma

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Cerebral blood flow (CBF) alterations following post-traumatic contusions have been demonstrated in recent papers. We evaluated regional CBF (rCBF) by means of Xenon-enhanced computerized tomography (Xe-CT) in 29 traumatic intracerebral hematomas, from 22 patients with severe head injury (GCS < or = 8). Fifty traumatic hematoma/Xe-CT CBF measurements were obtained from 39 Xe-CT studies performed during the acute phase (corresponding to the first 20 days post-injury). The rCBF was measured in three different regions of interest: the hemorrhagic core, the perihematoma edematous low-density area, and a 1-cm rim of perihematoma normal-appearing brain tissue, surrounding the edematous low-density area. We found a centrifugal improvement of rCBF as well as a decrease in the rates of CBF levels below 18 mL/100 g/min from the core to the periphery (p < 0.0001), which persisted over time. Ischemic rCBF values were detected in the perihematoma low-density area only in 24% of the traumatic hematomas. The time course of rCBF levels showed a reduced flow in the first 24 h, with a recovery of flow from day 2 to day 4, followed by another reduced flow (p < or = 0.0001) both in the perihematoma edematous low-density area and in the non-lesioned tissue. Our findings suggest that the only area with persistent ischemic values was the hemorrhagic core. Low rCBF levels seen in the perihematoma low-density area may only be ascribed partially to ischemia and can possibly recover over time. These results could encourage a surgical approach based on an early evacuation of the hemorrhagic core associated to a preservation of the surrounding edematous tissue.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Centrifugal Distribution of Regional Cerebral Blood Flow and its Time Course in Traumatic Intracerebral Hematomas

Chieregato

Fainardi²,

Servadei³

et al. 2004

Journal of Neurotrauma

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“…Focal perfusion abnormalities are typically observed in and around contusions, even before they become apparent on structural imaging (63)(64)(65). Perfusion, measured using Xenon-enhanced computed tomography (Xe-CT) (80)(81)(82)(83), CTP (63), and DSC-MRI (82)(83)(84), are altered in peri-contusional edematous regions, suggesting ongoing ischemic damage, and a role for perfusion imaging in prognosis (63,85). Focal brain perfusion abnormalities associated with extra-axial blood collections correlate with symptomatology.…”

Section: Conventional Mri Techniquesmentioning

confidence: 99%

Common data elements in radiologic imaging of traumatic brain injury

Haacke,

Duhaime,

Gean

et al. 2010

Magnetic Resonance Imaging

164

166

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Traumatic brain injury (TBI) has a poorly understood pathology. Patients suffer from a variety of physical and cognitive effects that worsen as the type of trauma worsens. Some noninvasive insights into the pathophysiology of TBI are possible using magnetic resonance imaging (MRI), computed tomography (CT), and many other forms of imaging as well. A recent workshop was convened to evaluate the common data elements (CDEs) that cut across the imaging field and given the charge to review the contributions of the various imaging modalities to TBI and to prepare an overview of the various clinical manifestations of TBI and their interpretation. Technical details regarding state-of-the-art protocols for both MRI and CT are also presented with the hope of guiding current and future research efforts as to what is possible in the field. Stress was also placed on the potential to create a database of CDEs as a means to best record information from a given patient from the reading of the images.

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“…Cortical contusions can lead to regional ischemia caused by extensive release of excitotoxic amino acids leading to increased cytotoxic brain edema and raised intracranial pressure [20].…”

Section: Cortical Contusionmentioning

confidence: 99%

Traumatic injuries: imaging of head injuries

Bešenski¹

2002

Eur Radiol

140

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Due to the forces of acceleration, linear translation, as well as rotational and angular acceleration, the brain undergoes deformation and distortion depending on the site of impact of traumatizing force direction, severity of the traumatizing force, and tissue resistance of the brain. Linear translation of accereration in a closed-head injury can run along the shorter diameter of the skull in latero-lateral direction causing mostly extra-axial lesions (subdural hematoma,epidural hematoma, subarachnoidal hemorrhage) or quite pronounced coup and countercoup contusions. Contusions are considerably less frequently present in medial or paramedial centroaxial blows (fronto-occipital or occipito-frontal). The centroaxial blows produce a different pattern of lesions mostly in the deep structures, causing in some cases a special category of the brain injury, the diffuse axonal injury (DAI). The brain stem can also be damaged, but it is damaged more often in patients who have suffered centroaxial traumatic force direction. Computed tomography and MRI are the most common techniques in patients who have suffered brain injury. Computed tomography is currently the first imaging technique to be used after head injury, in those settings where CT is available. Using CT, scalp, bone, extra-axial hematomas, and parenchymal injury can be demonstrated. Computed tomography is rapid and easily performed also in monitored patients. It is the most relevant imaging procedure for surgical lesions. Computed tomography is a suitable method to follow the dynamics of lesion development giving an insight into the corresponding pathological development of the brain injury. Magnetic resonance imaging is more sensitive for all posttraumatic lesions except skull fractures and subarachnoidal hemorrhage, but scanning time is longer, and the problem with the monitoring of patients outside the MRI field is present. If CT does not demonstrate pathology as can adequately be explained to account for clinical state, MRI is warranted. Follow-up is best done with MRI as it is more sensitive to parenchymal changes. In routine MR protocol gradient-recalled-echo sequences should be included at any other time after a traumatic event since they are very sensitive in detection of hemosiderin as well as former hematoma without hemosiderin. The MR signal intensity varies depending on sequences and time scanning after trauma.

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rCBF in Hemorrhagic, Non-Hemorrhagic and Mixed Contusions After Severe Head Injury and its Effect on Perilesional Cerebral Blood Flow

Cited by 15 publications

References 16 publications

Centrifugal Distribution of Regional Cerebral Blood Flow and its Time Course in Traumatic Intracerebral Hematomas

Centrifugal Distribution of Regional Cerebral Blood Flow and its Time Course in Traumatic Intracerebral Hematomas

Common data elements in radiologic imaging of traumatic brain injury

Traumatic injuries: imaging of head injuries

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