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Advanced Diffusion Imaging in The Hippocampus of Rats with Mild Traumatic Brain Injury
Published on: August 14, 2019
Diffuse axonal injury (DAI) is not associated with elevated intracranial pressure (ICP)
T T Lee1, M Galarza, P A Villanueva
1Department of Neurological Surgery, University of Miami School of Medicine, Florida, USA.
Acta Neurochirurgica
|April 2, 1998
Summary
Intracranial pressure (ICP) monitoring may not be critical for severe head trauma patients with diffuse axonal injury (DAI) but without mass lesions. These patients generally have lower ICP, reducing the need for invasive monitoring and associated complications.
Area of Science:
- Neuroscience
- Trauma Surgery
- Neurosurgery
Background:
- Severe head injury (Glasgow Coma Scale 3-8) traditionally necessitates intracranial pressure (ICP) monitoring.
- Ventriculostomy placement for ICP monitoring carries a 4-10% complication rate, including hematoma and infection.
- A specific subgroup of severe head trauma patients with diffuse axonal injury (DAI) and no mass lesions may not require ICP monitoring.
Purpose of the Study:
- To evaluate the necessity of ICP monitoring in severe head trauma patients diagnosed with DAI without associated mass lesions.
- To compare ICP, Mean Arterial Pressure (MAP), and Cerebral Perfusion Pressure (CPP) in DAI patients versus a control group.
Main Methods:
- Thirty-six patients with diagnosed DAI (based on clinical and CT scan criteria) were enrolled.
- Inclusion criteria: severe head injury, loss of consciousness, characteristic punctate hemorrhages (<10 mm), absence of mass lesions or anoxia.
- ICP and CPP were monitored and compared to a control group of 36 severe head injury patients without mass lesions using Analysis of Variance.
Main Results:
- DAI patients (n=36) showed a mean ICP of 11.70 mmHg, with 89.7% of readings ≤ 20 mmHg.
- Mean MAP was 96.08 mmHg (94.6% > 80 mmHg) and mean CPP was 85.16 mmHg (90.1% > 70 mmHg).
- DAI patient ICP values were significantly lower than the control group (11.70 vs 16.84 mmHg, p=0.000021). Only two DAI patients required ICP-related treatment.
- Complications were minimal (one hematoma, one ventriculitis).
- Clinical outcomes (GCS, GOS) were generally better for DAI types I and II compared to type III.
Conclusions:
- ICP elevation is less prevalent in DAI patients without mass lesions compared to other severe head injury patients, suggesting ICP monitoring may not be critical.
- ICP monitoring devices may contribute to increased morbidity.
- Accurate clinical history and CT scan interpretation are paramount for managing these patients.
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