Fawaz Al-Mufti1, Krishna Amuluru2, Megan Lander3, Melvin Mathew3, Mohammad El-Ghanem4, Rolla Nuoman5, Seami Park5, Vikas Patel6, Inder Paul Singh7, Gaurav Gupta8, Chirag D Gandhi9. 1. Department of Neurology, Neurosurgery, and Radiology, New York Medical College, Valhalla, New York, USA. Electronic address: fawazalmufti@outlook.com. 2. Department of Interventional Neuroradiology, University of Pittsburgh Medical Center-Hamot, Erie, Pennsylvania, USA. 3. Department of Neurosurgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA. 4. Department of Neurology and Medical Imaging, University of Arizona College of Medicine-Tucson, Tuscon, Arizona, USA. 5. Department of Neurology, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA. 6. Department of Neurology, Neurosurgery, and Radiology, New York Medical College, Valhalla, New York, USA; Department of Neurology, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA. 7. Department of Neurosurgery, Neurology, and Radiology, Mount Sinai Health System, New York, New York, USA. 8. Department of Neurosurgery, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA. 9. Department of Neurology, Neurosurgery, and Radiology, New York Medical College, Valhalla, New York, USA; Department of Neurosurgery, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA; Department of Neurology, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA; Department of Radiology, Rutgers University, New Jersey Medical School, Newark, New Jersey, USA.
Abstract
BACKGROUND: The exact mechanism, incidence, and risk factors for cerebral vasospasm after traumatic intracranial hemorrhage (ICH) continue to be poorly characterized. The incidence of post-traumatic vasospasm (PTV) varies depending on the detection modality. OBJECTIVE: We aimed to shed light on the predictors, associations, and true incidence of cerebral vasospasm after traumatic ICH using digital subtraction angiography (DSA) as the gold standard. METHODS: We examined a prospectively maintained database of traumatic brain injury (TBI) patients to identify patients with ICH secondary to TBI enrolled between 2002 and 2015 at our trauma center. Patients with TBI-associated ICH and evidence of elevated velocities on transcranial Doppler and computed tomography angiograms, confirmed with DSA were included. The diagnostic cerebral angiograms were evaluated by 2 blinded neurointerventionalists for cerebral vasospasm. Statistical analyses were conducted to determine predictors of PTV. RESULTS: Twenty patients with ICH secondary to TBI and evidence of vasospasm underwent DSAs. Seven patients (7/20; 35%) with traumatic ICH developed cerebral vasospasm and of those, 1 developed delayed cerebral ischemia (1/7; 14%). Of these 7 patients, 6 presented with subarachnoid hemorrhage (6/7; 85%). Vasospasm was substantially more common in patients with a Glasgow Coma Scale <9 (P = 0.017) than in all other groups. CONCLUSIONS: PTV as demonstrated by DCA may be more common than previously reported. Patients who exhibit PTV were more likely to have a Glasgow Coma Scale <9. This subgroup of patients may benefit from more systematic screening for the development of PTV, and earlier monitoring for signs of delayed cerebral ischemia.
BACKGROUND: The exact mechanism, incidence, and risk factors for cerebral vasospasm after traumatic intracranial hemorrhage (ICH) continue to be poorly characterized. The incidence of post-traumatic vasospasm (PTV) varies depending on the detection modality. OBJECTIVE: We aimed to shed light on the predictors, associations, and true incidence of cerebral vasospasm after traumatic ICH using digital subtraction angiography (DSA) as the gold standard. METHODS: We examined a prospectively maintained database of traumatic brain injury (TBI) patients to identify patients with ICH secondary to TBI enrolled between 2002 and 2015 at our trauma center. Patients with TBI-associated ICH and evidence of elevated velocities on transcranial Doppler and computed tomography angiograms, confirmed with DSA were included. The diagnostic cerebral angiograms were evaluated by 2 blinded neurointerventionalists for cerebral vasospasm. Statistical analyses were conducted to determine predictors of PTV. RESULTS: Twenty patients with ICH secondary to TBI and evidence of vasospasm underwent DSAs. Seven patients (7/20; 35%) with traumatic ICH developed cerebral vasospasm and of those, 1 developed delayed cerebral ischemia (1/7; 14%). Of these 7 patients, 6 presented with subarachnoid hemorrhage (6/7; 85%). Vasospasm was substantially more common in patients with a Glasgow Coma Scale <9 (P = 0.017) than in all other groups. CONCLUSIONS:PTV as demonstrated by DCA may be more common than previously reported. Patients who exhibit PTV were more likely to have a Glasgow Coma Scale <9. This subgroup of patients may benefit from more systematic screening for the development of PTV, and earlier monitoring for signs of delayed cerebral ischemia.