Significance of a reduced cerebral blood flow during the first 12 hours after traumatic brain injury

Roman Hlatky, Charles F. Contant, Pedro Diaz-Marchan, Alex B. Valadka, Claudia S. Robertson

Research output: Contribution to journalArticlepeer-review

39 Scopus citations

Abstract

Background: It is controversial whether a low cerebral blood flow (CBF) simply reflects the severity of injury or whether ischemia contributes to the brain's injury. It is also not clear whether posttraumatic cerebral hypoperf vision results from intracranial hypertension or from pathologic changes of the cerebral vasculature. The answers to these questions have important implications for whether and how to treat a low CBF. Methods: We performed a retrospective analysis of 77 patients with severe traumatic brain injury who had measurement of CBF within 12 hours of injury. CBF was measured using xenon-enhanced computed tomography (XeCT). Global CBF, physiological parameters at the time of XeCT, and outcome measures were analyzed. Results: Average global CBF for the 77 patients was 36 ± 16 mL/100 g/minutes. Nine patients had an average global CBF <18 (average 12 ± 5). The remaining 68 patients had a global CBF of 39 ± 15. The initial ICP was >20 mmHg in 90% and >30 mmHg in 80% of patients in the group with CBF <18, compared to 33% and 16%, respectively, in the patients with CBF ≥18. Mortality was 90% at 6 months postinjury in patients with CBF <18. Mortality in the patients with CBF >18 was 19% at 6 months after injury. Conclusion: In patients with CBF <18 mL/100 g/minutes, intracranial hypertension plays a major causative role in the reduction in CBF. Treatment would most likely be directed at controlling intracranial pressure, but the early, severe intracranial hypertension also probably indicates a severe brain injury. For levels of CBF between 18 and 40 mL/100 g/minutes, the presence of regional hypoperfusion was a more important factor in reducing the average CBF.

Original languageEnglish (US)
Pages (from-to)69-83
Number of pages15
JournalNeurocritical Care
Volume1
Issue number1
DOIs
StatePublished - 2004
Externally publishedYes

Keywords

  • Brain injury
  • Cerebral blood flow
  • Intracranial hypertension
  • Ischemia
  • Xenon-enhanced computed tomography

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

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