Cerebral vasospasm in diffuse axonal injury patients

Abstract

Background. Posttraumatic elevation of intracellular free calcium that is followed by increasing factors Such as endothelin can induce cerebral vasospasm. In this study, we investigated the occurrence and incidence of vasospasm in diffuse axonal injury (DAI) patients. Method. In this prospective Study, 35 DAI patients with a mean age of 28.0 +/- 14.2 were included. Their brain CT scan findings were compatible with types I to III categorizations of diffuse injury. They were studied with transcranial Doppler (TCD) on the first, third and tenth days of admission. Blood flow velocities in middle cerebral arteries (MCAs) were measured. We considered mean flow velocities >100cm/sec in the middle cerebral artery as vasospasm. Findings. Vasospasm was shown in 11 patients (31.4%). First, second and third TCD showed vasospasm in 7, 6, and 4 patients, respectively. Among 11 patients with vasospasm, 8 had poor outcome (72.7%), but in 24 patients without vasospasm, 14 patients showed poor outcome (58.3%) after one month follow-up. Conclusions. It seems that vasospasm onset following DAI is relatively earlier than vasospasm secondary to aneurysmal rupture. Whereas arterial vasospasm is an important sequel of head trauma with unfavorable effects on the outcome, early diagnosis and therapeutic intervention, can be critical.