+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Acute regional cerebral blood flow changes caused by severe head injuries

Acute regional cerebral blood flow changes caused by severe head injuries

Journal of Neurosurgery 74(3): 407-414

To evaluate the changes in cerebral blood flow (CBF) that occur immediately after head injury and the effects of different posttraumatic lesions on CBF, 61 CBF studies were obtained using the xenon-computerized tomography method in 32 severely head-injured adults (Glasgow Coma Scale score (GCS) less than or equal to 7). The measurements were made within 7 days after injury, 43% in the first 24 hours. During the 1st day, patients with an initial GCS score of 3 or 4 and no surgical mass had significantly lower flows than did those with a higher GCS score or mass lesions (p less than 0.05): in the first 1 to 4 hours, those without surgical mass lesions had a mean CBF of 27 cc/100 gm/min, which rose to 44 cc/100 gm/min by 24 hours. Patients without surgical mass lesions who died tended to have a lower global CBF than did those with better outcomes. Mass lesions were associated with a high global CBF and bihemispheric contusions with the lowest flows. By 24 hours after injury, global blood flow increased in groups that originally had low flows and decreased in those with very high initial flows, such that by 36 to 48 hours, most patients had CBF values between 32 and 55 cc/100 gm/min. Lobar, basal ganglion, and brain-stem blood flow values frequently differed by 25% or more from global averages. Brain-stem CBF varied the most but did not correlate with clinical signs of brain-stem dysfunction. Double studies were performed at two different pCO2 values in 10 patients with various posttraumatic lesions, and the CO2 vasoresponsivity was calculated. Abnormal CO2 vasoresponsivity was found with acute subdural hematomas and defuse cerebral swelling but not with epidural hematomas. In patients without surgical mass lesions, the findings suggest that CBF in the first few hours after injury is often low, followed by a hyperemic phase that peaks at 24 hours. Global CBF values vary widely depending on the type of traumatic brain injury, and brain-stem flow is often not accurately reflected by global CBF values. These findings underscore the need to define regional CBF abnormalities in victims of severe head injury if treatment is intended to prevent regional ischemia.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 006986303

Download citation: RISBibTeXText

PMID: 1899694

DOI: 10.3171/jns.1991.74.3.0407

Related references

Compartmental analysis of regional cerebral blood flow in patients with acute severe head injuries. Journal of Neurosurgery 47(5): 699-712, 1977

Regional cerebral blood flow and intraventricular pressure in acute head injuries. Journal of Neurology Neurosurgery and Psychiatry 37(12): 1378-1388, 1974

Reproducibility of regional cerebral blood flow measurements in acute severe head injury. Journal of Neurosurgery 49(3): 366-377, 1978

Perfusion pressures correlated with regional cerebral blood flow electro encephalogram and aorto cervical angiography in patients with acute head injuries progressing to brain death. Panminerva Medica 13(5): 205-206, 1971

Perfusion pressure and cerebral blood flow in severe head injuries. Agressologie: Revue Internationale de Physio-Biologie et de Pharmacologie Appliquees Aux Effets de l'Agression 25(6): 687-690, 1984

Cerebral blood flow measurements after spontaneous subarachnoid hemorrhage and after severe head injuries. Panminerva Medica 13(5), 1971

Intra cranial pressure cerebral blood flow and prognosis in patients with severe head injuries. Stroke 4(3): 348, 1973

Topographic correlation of regional cerebral blood flow (rCBF) and electroencephalogram in severe cranial injuries. Minerva Anestesiologica 57(10): 998-999, 1991

The use of stable xenon-enhanced computed tomographic studies of cerebral blood flow to define changes in cerebral carbon dioxide vasoresponsivity caused by a severe head injury. Neurosurgery 29(6): 869-873, 1991

The Use of Stable Xenon-Enhanced Computed Tomographic Studies of Cerebral Blood Flow to Define Changes in Cerebral Carbon Dioxide Vasoresponsivity Caused by a Severe Head Injury. Neurosurgery 29(6): 869-873, 1991

Cerebral blood flow and metabolism in children with severe head injuries. Part 2: Cerebrovascular resistance and its determinants. Journal of Neurology, Neurosurgery, and Psychiatry 58(2): 153-159, 1995

Effects of decompressive craniectomy on regional cerebral blood flow in severe head trauma patients. Neurologia Medico-Chirurgica 33(9): 616-620, 1993

Regional Cerebral Blood Flow and Intraventricular Pressure in Acute Brain Injuries. European Neurology 8(1-4): 192-199, 1972

Regional cerebral blood flow and intraventricular pressure in acute brain injuries. European Neurology 8(1): 192-199, 1972

Acta neurochirurgica supplementum vol 49 cerebral blood flow in acute head injury the regulation of cerebral blood flow and metabolism during the acute phase of head injury and its significance for therapy. Cold, G E Acta Neurochirurgica Supplementum, Vol 49 Cerebral Blood Flow in Acute Head Injury: The Regulation Of Cerebral Blood Flow And Metabolism During The Acute Phase Of Head Injury, And Its Significance For Therapy Viii+64p Springer-Verlag: Vienna, Austria; New York, New York, Usa Illus Viii+64p, 1990