NYMC Faculty Publications

Title

Low Glasgow Coma Score in Traumatic Intracranial Hemorrhage Predicts Development of Cerebral Vasospasm

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.

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