Dataset Information

Spatial and Temporal Pattern of Ischemia and Abnormal Vascular Function Following Traumatic Brain Injury.

ABSTRACT:

Importance

Ischemia is an important pathophysiological mechanism after traumatic brain injury (TBI), but its incidence and spatiotemporal patterns are poorly characterized.

Objective

To comprehensively characterize the spatiotemporal changes in cerebral physiology after TBI.

Design, setting, and participants

This single-center cohort study uses 15oxygen positron emission tomography data obtained in a neurosciences critical care unit from February 1998 through July 2014 and analyzed from April 2018 through August 2019. Patients with TBI requiring intracranial pressure monitoring and control participants were recruited.

Exposures

Cerebral blood flow (CBF), cerebral blood volume (CBV), cerebral oxygen metabolism (CMRO2), and oxygen extraction fraction.

Main outcomes and measures

Ratios (CBF/CMRO2 and CBF/CBV) were calculated. Ischemic brain volume was compared with jugular venous saturation and brain tissue oximetry.

Results

A total of 68 patients with TBI and 27 control participants were recruited. Results from 1 patient with TBI and 7 health volunteers were excluded. Sixty-eight patients with TBI (13 female [19%]; median [interquartile range (IQR)] age, 29 [22-47] years) underwent 90 studies at early (day 1 [n?=?17]), intermediate (days 2-5 [n?=?54]), and late points (days 6-10 [n?=?19]) and were compared with 20 control participants (5 female [25%]; median [IQR] age, 43 [31-47] years). The global CBF and CMRO2 findings for patients with TBI were less than the ranges for control participants at all stages (median [IQR]: CBF, 26 [22-30] mL/100 mL/min vs 38 [29-49] mL/100 mL/min; P?Conclusions and relevanceIschemia is common early, detectable up to 10 days after TBI, possible without intracranial hypertension, and inconsistently detected by jugular or brain tissue oximetry. There is substantial between-patient and within-patient pathophysiological heterogeneity; ischemia and hyperemia commonly coexist, possibly reflecting abnormalities in flow-metabolism coupling. Increased CBV may contribute to intracranial hypertension but can coexist with abnormal CBF/CBV ratios. These results emphasize the need to consider cerebrovascular pathophysiological complexity when managing patients with TBI.

SUBMITTER: Launey Y

PROVIDER: S-EPMC6865302 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Spatial and Temporal Pattern of Ischemia and Abnormal Vascular Function Following Traumatic Brain Injury.

Launey Yoann Y Fryer Tim D TD Hong Young T YT Steiner Luzius A LA Nortje Jurgens J Veenith Tonny V TV Hutchinson Peter J PJ Ercole Ari A Gupta Arun K AK Aigbirhio Franklin I FI Pickard John D JD Coles Jonathan P JP Menon David K DK

JAMA neurology 20200301 3

<h4>Importance</h4>Ischemia is an important pathophysiological mechanism after traumatic brain injury (TBI), but its incidence and spatiotemporal patterns are poorly characterized.<h4>Objective</h4>To comprehensively characterize the spatiotemporal changes in cerebral physiology after TBI.<h4>Design, setting, and participants</h4>This single-center cohort study uses 15oxygen positron emission tomography data obtained in a neurosciences critical care unit from February 1998 through July 2014 and ...[more]

PMID: 31710336

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Dataset Information

Spatial and Temporal Pattern of Ischemia and Abnormal Vascular Function Following Traumatic Brain Injury.

Importance

Objective

Design, setting, and participants

Exposures

Main outcomes and measures

Results

Publications

Spatial and Temporal Pattern of Ischemia and Abnormal Vascular Function Following Traumatic Brain Injury.

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