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Posttraumatic cerebral vasospasm: clinical and morphological presentations
A Y Zubkov1, A S Pilkington, D H Bernanke
1Department of Neurosugery, The University of Mississippi Medical Center, Jackson 39216-4505, USA. azubkov@neurosurgery.umsmed.edu
Insights
Posttraumatic cerebral vasospasm occurs in 32% of head injury patients and is linked to injury severity. Morphologically, it resembles aneurysmal vasospasm, indicating similar underlying changes.
Area of Science:
- Neurology
- Trauma Surgery
- Pathology
Background:
- Head injury is a major cause of death and disability, particularly in young individuals.
- Posttraumatic cerebral vasospasm is a complicating factor that can worsen patient outcomes.
- Understanding the characteristics of posttraumatic vasospasm is crucial for improving patient management.
Purpose of the Study:
- To investigate the incidence and characteristics of posttraumatic cerebral vasospasm in head injury patients.
- To correlate the development of posttraumatic vasospasm with injury severity.
- To compare the morphological features of posttraumatic vasospasm with aneurysmal vasospasm.
Main Methods:
- A study of 75 patients admitted with head injury at the University of Mississippi Medical Center.
- Assessment of patient demographics, injury type, and severity using the Glasgow Coma Scale (GCS).
- Detection of posttraumatic vasospasm and morphological analysis of vascular changes.
Main Results:
- Posttraumatic vasospasm was detected in 32% of patients (24 out of 75).
- A significant correlation was found between injury severity (GCS scores) and the development of vasospasm.
- Morphological examination revealed increased corrugation of the internal elastic lamina and subendothelial connective tissue, similar to aneurysmal vasospasm.
Conclusions:
- Posttraumatic vasospasm is a notable complication of head injury, occurring more frequently in severe cases.
- Despite being clinically milder, posttraumatic vasospasm shares morphological similarities with aneurysmal vasospasm.
- These findings suggest common pathophysiological mechanisms underlying both conditions.
Abstract:
Head injury is one of the leading causes of morbidity and mortality in the young population. Many factors complicate head injury and worsen an outcome. One of these factors is posttraumatic cerebral vasospasm. We studied 75 patients admitted to the University of Mississippi Medical Center with head injury. Their ages ranged from 14 to 67 years (mean 30 years, SD 11.63). Eighty percent of the patients were men, and 20% were women. Of these patients, 53 (70.6%) suffered severe blunt trauma, and 4 patients suffered gunshot wounds to the head. Four patients had mild head injury, and 14 had moderate head injury. Posttraumatic vasospasm was detected in 24 (32%) patients. Among these patients, 19 (79.2%) had severe closed head injury, 3 patients had moderate head injury, and 2 suffered gunshot wounds. The severity of the patient's respective condition was correlated with the development of posttraumatic cerebral vasospasm: 50% of the patients with Glasgow Coma Scale (GCS) 3-4 developed PTV, and only 30% with GCS 9-11, and none of the patients with GCS > 12 developed PTV. Overall, posttraumatic vasospasm started earlier and had a shorter course than did aneurysmal vasospasm. Morphologically, posttraumatic vasospasm resembled the features of aneurysmal vasospasm. We found increased corrugation of the internal elastic lamina and increased amounts of connective tissue in the subendothelial layer. These findings show that posttraumatic vasospasm, although clinically more mild, demonstrates the same morphological changes as aneurysmal vasospasm.