Incidence and mechanisms of cerebral ischemia in early clinical head injury.

Détails

ID Serval
serval:BIB_9EF5FE630CF8
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Incidence and mechanisms of cerebral ischemia in early clinical head injury.
Périodique
Journal of Cerebral Blood Flow and Metabolism
Auteur(s)
Coles J.P., Fryer T.D., Smielewski P., Chatfield D.A., Steiner L.A., Johnston A.J., Downey S.P., Williams G.B., Aigbirhio F., Hutchinson P.J., Rice K., Carpenter T.A., Clark J.C., Pickard J.D., Menon D.K.
ISSN
0271-678X
Statut éditorial
Publié
Date de publication
2004
Peer-reviewed
Oui
Volume
24
Numéro
2
Pages
202-211
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Résumé
Antemortem demonstration of ischemia has proved elusive in head injury because regional CBF reductions may represent hypoperfusion appropriately coupled to hypometabolism. Fifteen patients underwent positron emission tomography within 24 hours of head injury to map cerebral blood flow (CBF), cerebral oxygen metabolism (CMRO2), and oxygen extraction fraction (OEF). We estimated the volume of ischemic brain (IBV) and used the standard deviation of the OEF distribution to estimate the efficiency of coupling between CBF and CMRO2. The IBV in patients was significantly higher than controls (67 +/- 69 vs. 2 +/- 3 mL; P < 0.01). The coexistence of relative ischemia and hyperemia in some patients implies mismatching of perfusion to oxygen use. Whereas the saturation of jugular bulb blood (SjO2) correlated with the IBV (r = 0.8, P < 0.01), SjO2 values of 50% were only achieved at an IBV of 170 +/- 63 mL (mean +/- 95% CI), which equates to 13 +/- 5% of the brain. Increases in IBV correlated with a poor Glasgow Outcome Score 6 months after injury (rho = -0.6, P < 0.05). These results suggest significant ischemia within the first day after head injury. The ischemic burden represented by this "traumatic penumbra" is poorly detected by bedside clinical monitors and has significant associations with outcome.
Mots-clé
Adolescent, Adult, Aged, Brain/anatomy & histology, Brain/metabolism, Brain Ischemia/epidemiology, Brain Ischemia/pathology, Cerebrovascular Circulation, Craniocerebral Trauma/pathology, Craniocerebral Trauma/physiopathology, Female, Humans, Male, Middle Aged, Oxygen/metabolism, Oxygen Consumption, Regional Blood Flow, Tomography, Emission-Computed
Pubmed
Web of science
Création de la notice
29/12/2009 18:02
Dernière modification de la notice
03/03/2018 20:01
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