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