Does Traumatic Subarachnoid Hemorrhage Caused by Diffuse Brain Injury Cause Delayed Ischemic Brain Damage? Comparison with Subarachnoid Hemorrhage Caused by Ruptured Intracranial Aneurysms

Does Traumatic Subarachnoid Hemorrhage Caused by Diffuse Brain Injury Cause Delayed Ischemic... AbstractOBJECTIVETo examine whether traumatic subarachnoid hemorrhage (TSAH) caused by severe diffuse brain injury leads to delayed ischemic brain damage and secondary deterioration of outcome, as does aneurysmal subarachnoid hemorrhage (ASAH).METHODSWe examined 99 patients with diffuse brain injury with TSAH and 114 patients with ASAH. Computed tomographic (CT) findings, cerebral blood flow, and neurological outcomes were assessed during the acute and subacute phases and were compared between the two groups.RESULTSThe distribution of subarachnoid hemorrhage on the CT scans differed between the two groups. Unlike ASAH, TSAH was not limited to cisterns surrounding the circle of Willis but extended to supratentorial regions and interhemispheric fissures. Computed tomography-detected subarachnoid hemorrhage disappeared very early with TSAH and gradually with ASAH. In the ASAH group, mean cerebral blood flow decreased to 75% of normal during the acute phase and decreased a further 10% during the subacute phase. In the TSAH group, mean cerebral blood flow decreased to 85% of normal during the acute phase and increased slightly during the subacute phase. Neurological deterioration and in-hospital death peaked on Day 0 in association with TSAH and showed twin peaks in association with ASAH. The incidence of low-density areas on the CT scans was significantly higher with ASAH than with TSAH. All low-density areas on the CT scans of patients with ASAH corresponded to vascular territories, but low-density areas on the CT scans of patients with TSAH were rarely associated with vascular territories and contained deep-seated or gliding contusion types.CONCLUSIONThe findings suggest that the incidence of vasospasm is low in association with TSAH and that the cause is different compared with ASAH. There is no evidence that the presence of TSAH in cases of diffuse brain injury leads to delayed ischemic brain damage and secondary deterioration of outcome. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Does Traumatic Subarachnoid Hemorrhage Caused by Diffuse Brain Injury Cause Delayed Ischemic Brain Damage? Comparison with Subarachnoid Hemorrhage Caused by Ruptured Intracranial Aneurysms

Does Traumatic Subarachnoid Hemorrhage Caused by Diffuse Brain Injury Cause Delayed Ischemic Brain Damage? Comparison with Subarachnoid Hemorrhage Caused by Ruptured Intracranial Aneurysms

CLINICAL STUDIES Does Traumatic Subarachnoid Hemorrhage Caused by Diffuse Brain Injury Cause Delayed Ischemic Brain Damage? Comparison with Subarachnoid Hemorrhage Caused by Ruptured Intracranial Aneurysms Tadaharu Fukuda, M.D., Masamichi Hasue, M.D., Hiroshi Ito, M.D. D epartm ent o f Neurosurgery, H a c h io u ji M e d ic a l Center, T o k y o M e d ic a l College, Tokyo, Japan O B JE C T IV E : To examine whether traumatic subarachnoid hemorrhage (TSAH) caused by severe diffuse brain injury leads to delayed ischemic brain damage and secondary deterioration of outcome, as does aneurysmal subarach­ noid hemorrhage (ASAH). M E T H O D S : We examined 99 patients with diffuse brain injury with TSA H and 114 patients with A SA H . Computed tomographic (CT) findings, cerebral blood flow, and neurological outcomes were assessed during the acute and subacute phases and were compared between the two groups. RESULTS: The distribution of subarachnoid hemorrhage on the C T scans differed between the two groups. Unlike A SA H , TSA H was not limited to cisterns surrounding the circle of W illis but extended to supratentorial regions and interhemispheric fissures. Computed tomography-detected subarachnoid hemorrhage disappeared very early with TSA H and gradually with A SA H . In the ASAH group, mean cerebral blood flow decreased to 7 5 % of normal during the acute phase and decreased a further 1 0 % during the subacute phase. In the TSA H group, mean cerebral blood flow decreased to 8 5 % of normal during the acute phase and increased slightly during the subacute phase. Neurological deterioration and in-hospital death peaked on Day 0 in association with TSAH and showed twin peaks in association with A SA H . The incidence of low-density areas on the C T scans was significantly higher with ASAH than with TSA H . All low-density areas on the C T scans of patients with A SA H corresponded to vascular territories, but low-density areas on the C T scans of patients with TSA...
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Publisher
Oxford University Press
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199811000-00022
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVETo examine whether traumatic subarachnoid hemorrhage (TSAH) caused by severe diffuse brain injury leads to delayed ischemic brain damage and secondary deterioration of outcome, as does aneurysmal subarachnoid hemorrhage (ASAH).METHODSWe examined 99 patients with diffuse brain injury with TSAH and 114 patients with ASAH. Computed tomographic (CT) findings, cerebral blood flow, and neurological outcomes were assessed during the acute and subacute phases and were compared between the two groups.RESULTSThe distribution of subarachnoid hemorrhage on the CT scans differed between the two groups. Unlike ASAH, TSAH was not limited to cisterns surrounding the circle of Willis but extended to supratentorial regions and interhemispheric fissures. Computed tomography-detected subarachnoid hemorrhage disappeared very early with TSAH and gradually with ASAH. In the ASAH group, mean cerebral blood flow decreased to 75% of normal during the acute phase and decreased a further 10% during the subacute phase. In the TSAH group, mean cerebral blood flow decreased to 85% of normal during the acute phase and increased slightly during the subacute phase. Neurological deterioration and in-hospital death peaked on Day 0 in association with TSAH and showed twin peaks in association with ASAH. The incidence of low-density areas on the CT scans was significantly higher with ASAH than with TSAH. All low-density areas on the CT scans of patients with ASAH corresponded to vascular territories, but low-density areas on the CT scans of patients with TSAH were rarely associated with vascular territories and contained deep-seated or gliding contusion types.CONCLUSIONThe findings suggest that the incidence of vasospasm is low in association with TSAH and that the cause is different compared with ASAH. There is no evidence that the presence of TSAH in cases of diffuse brain injury leads to delayed ischemic brain damage and secondary deterioration of outcome.

Journal

NeurosurgeryOxford University Press

Published: Nov 1, 1998

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