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Cerebral vasospasm after traumatic brain injury: an update
1Département d'Anesthésie Réanimation, Hôpital Central, Centre Hospitalier Universitaire de Nancy, Nancy, France - a.baumann@chu-nancy.fr.
Minerva Anestesiologica
|September 16, 2015
Summary
Post-traumatic vasospasm (PTV) affects up to 40% of severe traumatic brain injury patients, often within 3 days. Early diagnosis and understanding PTV pathophysiology are crucial for improving patient outcomes.
Area of Science:
- Neuroscience
- Trauma Surgery
- Critical Care Medicine
Background:
- Post-traumatic vasospasm (PTV) is a poorly understood complication following traumatic brain injury (TBI).
- Understanding the incidence, mechanisms, risk factors, and outcomes of PTV is critical for patient management.
Purpose of the Study:
- To systematically review the existing literature on post-traumatic vasospasm.
- To examine the incidence, pathophysiology, risk factors, diagnostic methods, and therapeutic options for PTV.
Main Methods:
- Systematic review of Medline database up to 2015 using keywords 'traumatic brain injury' and 'vasospasm'.
- Analysis of 429 retrieved references, with 87 ultimately included based on PRISMA criteria and clinical relevance.
- Focus on human clinical practice and relevance.
Main Results:
- PTV occurs in 30-40% of severe TBI patients, typically starting within 3 days and lasting 5-10 days.
- Risk factors include young age, low Glasgow Coma Score, and subarachnoid hemorrhage.
- Diagnosis confirmed by angiography (CTA, MRA); perfusion imaging assesses ischemic consequences. Early PTV correlates with poor outcomes.
Conclusions:
- Pathophysiology involves mechanical stretching, inflammation, calcium dysregulation, endothelin, contractile proteins, and cortical spreading depolarization.
- No current prevention strategies are proven effective; nimodipine and intra-arterial papaverine are studied treatments.
- Milrinone shows potential as a novel therapeutic option for PTV.
