Document Detail


Posttraumatic vasospasm detected by continuous brain tissue oxygen monitoring: treatment with intraarterial verapamil and balloon angioplasty.
MedLine Citation:
PMID:  18807219     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Posttraumatic vasospasm (PTV) is a relatively common event following traumatic brain injury (TBI) that has been strongly correlated with worse neurological outcome in many studies. However, vasospasm continues to be an under-recognized source of secondary injury following TBI, and currently published guidelines do not address screening or management strategies for PTV. Brain tissue oxygen (P(bt)O(2)) monitoring probes allow for continuous screening for cerebral hypoxia following TBI, but their use as a monitor for PTV has not been previously described. METHODS: Case report and literature review. RESULTS: We present a case of PTV identified by persistent low P(bt)O(2) despite aggressive medical therapy. Computed tomography and digital subtraction angiography confirmed severe cerebral arterial vasospasm involving both anterior and posterior circulations. The patient was successfully treated with serial intraarterial therapy including balloon angioplasty and verapamil infusion. CONCLUSION: Posttraumatic vasospasm should be included in the differential diagnosis of cerebral hypoxia (e.g., low P(bt)O(2)) following TBI. Management strategies for PTV may include early, aggressive intraarterial therapies including drug infusion and balloon angioplasty.
Authors:
Kiarash Shahlaie; James E Boggan; Richard E Latchaw; Cheng Ji; J Paul Muizelaar
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Publication Detail:
Type:  Case Reports; Journal Article; Review     Date:  2008-09-20
Journal Detail:
Title:  Neurocritical care     Volume:  10     ISSN:  1541-6933     ISO Abbreviation:  Neurocrit Care     Publication Date:  2009  
Date Detail:
Created Date:  2009-01-21     Completed Date:  2009-03-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101156086     Medline TA:  Neurocrit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  61-9     Citation Subset:  IM    
Affiliation:
Department of Neurological Surgery, University of California, Davis Medical Center, Sacramento, CA 95817, USA. krshahlaie@ucdavis.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Angioplasty, Balloon*
Brain Injuries / complications*,  diagnosis,  metabolism
Female
Humans
Monitoring, Physiologic
Oxygen Consumption / physiology
Vasodilator Agents / therapeutic use*
Vasospasm, Intracranial / diagnosis*,  etiology,  therapy*
Verapamil / therapeutic use*
Chemical
Reg. No./Substance:
0/Vasodilator Agents; 52-53-9/Verapamil

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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