TY - JOUR
T1 - Posttraumatic vasospasm and intracranial hypertension after wartime traumatic brain injury
AU - Armondaa, Rocco A.
AU - Tignob, Teodoro A.
AU - Hochheimera, Sven M.
AU - Stephensa, Fred L.
AU - Bell, Randy S.
AU - Vo, Alexander H.
AU - Severson, Meryl A.
AU - Marshall, Scott A.
AU - Oppenheimer, Stephen M.
AU - Ecker, Robert
AU - Razumovsky, Alexander
N1 - Funding Information:
This paper was supported in part by the US 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., Sc.D., Assistant Professor, Director of the Spine Outcomes Research Center at the Johns Hopkins University for his statistical assistance and guidance (Baltimore, MD, USA). Also we need to thank neurosonographers Dr. A. Dzhanashvili, M.D., RVS and Mirkko Galdo who have been responsible for data collection.
PY - 2012/9
Y1 - 2012/9
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 US Army Medical Department initiated a transcranial Doppler (TCD) ultrasound service for TBI patients; included patients were retrospectively evaluated for TCD-determined incidence of posttraumatic cerebral vasospasm and intracranial hypertension after wartime TBI. Ninety patients were investigated with daily TCD studies and comprehensive TCD protocol and published diagnostic criteria for vasospasm and raised 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%, five 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 US Army Medical Department initiated a transcranial Doppler (TCD) ultrasound service for TBI patients; included patients were retrospectively evaluated for TCD-determined incidence of posttraumatic cerebral vasospasm and intracranial hypertension after wartime TBI. Ninety patients were investigated with daily TCD studies and comprehensive TCD protocol and published diagnostic criteria for vasospasm and raised 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%, five 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
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U2 - 10.1016/j.permed.2012.02.043
DO - 10.1016/j.permed.2012.02.043
M3 - Article
AN - SCOPUS:84867580933
SN - 2211-968X
VL - 1-12
SP - 261
EP - 264
JO - Perspectives in Medicine
JF - Perspectives in Medicine
ER -