| Early Parenchymal Contrast Extravasation Predicts Subsequent Hemorrhage Progression, Clinical Deterioration, and Need for Surgery in Patients With Traumatic Cerebral Contusion. | |
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MedLine Citation:
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PMID: 22182869 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND:: This study aimed to identify early radiologic signs that are predictive of hemorrhage progression and clinical deterioration in patients with traumatic cerebral contusion. We hypothesized that contrast extravasation (CE) and blood-brain barrier disruption might be associated with hemorrhage progression, brain edema, and clinical deterioration in these patients. METHODS:: Twenty-two patients with traumatic cerebral contusion (diagnosed on initial noncontrast head computed tomography [CT]) who initially did not require surgical intervention were enrolled in this study. Contrast-enhanced and perfusion CT scans were performed within 6 hours of injury, and follow-up noncontrast CT scans were performed at 24 hours and 72 hours. RESULTS:: In each noncontrast CT scan, the volumes of the contusion hemorrhage and edema were calculated using computerized planimetric techniques. The initial Glasgow Coma Scale, hemorrhage progression, clinical deterioration, and the need for subsequent surgery were recorded. The early radiologic findings were compared with these parameters and functional outcome at 6 months to identify predictive radiologic signs. CE was present in 9 of 22 patients (41%) and was highly associated with hemorrhage progression (p < 0.05), clinical deterioration (p < 0.01), and need for subsequent surgery (p < 0.01). In addition, patients with CE had a greater volume of edema at 24 hours (p < 0.01) and 72 hours (p < 0.01) than those who did not have CE. However, CE was not found to be associated with poor outcome. CONCLUSIONS:: Early parenchymal CE is associated with hemorrhage progression, cerebral edema, clinical deterioration, and need for subsequent surgery. These patients should be monitored closely, and early surgery may be needed if deterioration occurs. Further elucidation of the pathophysiology is needed to formulate effective treatment for these high-risk patients. |
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Authors:
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Abel Po-Hao Huang; Chung-Wei Lee; Hong-Jen Hsieh; Chi-Cheng Yang; Yi-Hsin Tsai; Fon-Yih Tsuang; Lu-Ting Kuo; Yuan-Shen Chen; Yong-Kwang Tu; Sheng-Jean Huang; Hon-Man Liu; Jui-Chang Tsai |
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Publication Detail:
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Type: JOURNAL ARTICLE |
Journal Detail:
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Title: The Journal of trauma Volume: 71 ISSN: 1529-8809 ISO Abbreviation: - Publication Date: 2011 Dec |
Date Detail:
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Created Date: 2011-12-20 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376373 Medline TA: J Trauma Country: - |
Other Details:
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Languages: ENG Pagination: 1593-1599 Citation Subset: - |
Affiliation:
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From the Division of Neurosurgery, Department of Surgery (A.P.-H.H., Y.-H.T., F.-Y.T., L.-T.K., Y.-S.C., Y.-K.T., S.-J.H., J.-C.T.), Department of Traumatology (Y.-H.T., S.-J.H.), and Department of Radiology (C.-W.L., H.-M.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Departments of Surgery (A.P.-H.H., L.-T.K., Y.-S.C., S.-J.H.) and Radiology (H.-J.H.), National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan; Center for Optoelectronic Biomedicine (J.-C.T.), National Taiwan University College of Medicine, Taipei, Taiwan; and Department of Occupational Therapy & Graduate Institute of Clinical Behavioral Science (C.-C.Y.), Chang-Gung University, Taoyuan, Taiwan. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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