NYMC Faculty Publications
Low Glasgow Coma Score in Traumatic Intracranial Hemorrhage Predicts Development of Cerebral Vasospasm
Journal Title
World Neurosurgery
First Page
e68
Last Page
e71
Document Type
Article
Publication Date
December 2018
Department
Neurosurgery
Abstract
BACKGROUND: The exact mechanism, incidence and risk factors for cerebral vasospasm following traumatic intracranial hemorrhage (ICH) continues 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 following 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 CT angiograms, confirmed with digital subtraction angiography (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 20 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, one developed delayed cerebral ischemia (DCI) (1/7; 14%). Of these 7 patients, 6 presented with subarachnoid hemorrhage (SAH) (6/7; 85%). Vasospasm was substantially more common in patients with a Glasgow Coma Scale (GCS)<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 GCS <9. This subgroup of patients may benefit from more systematic screening for the development of PTV, and earlier monitoring for signs of DCI.
Recommended Citation
Al-Mufti, F., Amuluru, K., Lander, M., Mathew, M., El-Ghanem, M., Nuoman, R., Park, S., Patel, V., Singh, I., Gupta, G., & Gandhi, C. (2018). Low Glasgow Coma Score in Traumatic Intracranial Hemorrhage Predicts Development of Cerebral Vasospasm. World Neurosurgery, 120, e68-e71. https://doi.org/10.1016/j.wneu.2018.07.143