Skip to main content
SpringerLink
Log in

The Cerebrovascular Resistance in Combined Traumatic Brain Injury with Intracranial Hematomas

  • Conference paper
  • First Online:
Intracranial Pressure & Neuromonitoring XVI

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 126))

Abstract

Objective: The aim was to evaluate changes in cerebrovascular resistance (CVR) in combined traumatic brain injury (CTBI) in groups with and without intracranial hematomas (IH).

Materials and Methods: Treatment outcomes in 70 patients with CTBI (42 males and 28 females) were studied. Mean age was 35.5 ± 14.8 years (range, 15–73). The patients were divided into two groups: group 1 included 34 CTBI patients without hematomas; group 2 comprised 36 patients with CTBI and IH. The severity according to the Glasgow Coma Scale averaged 10.4 ± 2.6 in group 1, and 10.6 ± 2.8 in group 2. All patients underwent perfusion computed tomography (CT) and transcranial Doppler of both middle cerebral arteries. Cerebral perfusion pressure and CVR were calculated.

Results: The mean CVR values in each group (both with and without hematomas) appeared to be statistically significantly higher than the mean normal value. Intergroup comparison of CVR values showed statistically significant increase in the CVR level in group 2 on the side of the removed hematoma (р = 0.037). CVR in the perifocal zone of the removed hematoma remained significantly higher compared with the symmetrical zone in the contralateral hemisphere (p = 0.0009).

Conclusion: CVR in patients with CTBI is significantly increased compared to the normal value and remains elevated after evacuation of hematoma in the perifocal zone compared to the symmetrical zone in the contralateral hemisphere. This is indicative of certain correlation between the mechanisms of cerebral blood flow autoregulation and maintaining CVR.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Rhee C. The ontogeny of cerebrovascular pressure autoregulation in premature infants. Acta Neurochir Suppl. 2016;122:151–5.

    Article  PubMed  Google Scholar 

  2. Westermaier T. Value of transcranial Doppler, perfusion-CT and neurological evaluation to forecast secondary ischemia after aneurysmal SAH. Neurocrit Care. 2014;20(3):406–12.

    Article  PubMed  Google Scholar 

  3. Trofimov A. Intrahospital transfer of patients with traumatic brain injury: increase in intracranial pressure. Acta Neurochir Suppl. 2016;122:125–7.

    Article  PubMed  Google Scholar 

  4. Dewey R. Experimental cerebral hemodynamics. Vasomotor tone, critical closing pressure, and vascular bed resistance. J Neurosurg. 1974;41(5):597–606.

    Article  CAS  PubMed  Google Scholar 

  5. Sharples PM. Cerebral blood flow and metabolism in children with severe head injuries. Part 2: cerebrovascular resistance and its determinants. J Neurol Neurosurg Psychiatry. 1995;58(2):153–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Daley M. Model-derived assessment of cerebrovascular resistance and cerebral blood flow following traumatic brain injury. Exp Biol Med (Maywood). 2010;235(4):539–45.

    Article  CAS  Google Scholar 

  7. Smirl JD. Influence of cerebrovascular resistance on the dynamic relationship between blood pressure and cerebral blood flow in humans. J Appl Physiol. 2014;116(12):1614–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Bragin DE. High intracranial pressure effects on cerebral cortical microvascular flow in rats. J Neurotrauma. 2011;28(5):775–85.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Pluta RM. Delayed cerebral vasospasm and nitric oxide: review, new hypothesis, and proposed treatment. Pharmacol Ther. 2005;105(1):23–56.

    Article  CAS  PubMed  Google Scholar 

  10. Czosnyka M, Smielewski P, et al. Continuous assessment of the cerebral vasomotor reactivity in head injury. Neurosurgery. 1997;41(1):11–9.

    Article  CAS  PubMed  Google Scholar 

  11. Scheinberg P. The cerebral blood flow in male subjects as measured by the nitrous oxide technique. Normal values for blood flow, oxygen utilization, glucose utilization, and peripheral resistance, with observations on the effect of tilting and anxiety. J Clin Invest. 1949;28(5):1163–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Marmarou A. A review of progress in understanding the pathophysiology and treatment of brain edema. Neurosurg Focus. 2007;22(5):E1.

    Article  Google Scholar 

  13. Bullock R. Glial swelling following human cerebral contusion: an ultrastructural study. J Neurol Neurosurg Psychiatry. 1991;54(5):427–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Hall CN. Capillary pericytes regulate cerebral blood flow in health and disease. Nature. 2014;508(7494):55–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Conflicts of interest statement

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Nizhniy Novgorod State Medical Academy, 1, Minin Sq., Nizhniy Novgorod, 603950, Russia

    Alex O. Trofimov M.D.

  2. Department of Polytrauma, Nizhniy Novgorod Regional Hospital, named after N.A. Semashko, 190, Rodionov Str., Nizhniy, Novgorod, 603126, Russia

    Alex O. Trofimov M.D.

  3. Department of Neurosurgery, Nizhniy Novgorod State Medical Academy, 190, Rodionov Str., Nizhniy Novgorod, 603950, Russia

    George Kalentyev, Oleg Voennov, Michail Yuriev & Vera Grigoryeva

  4. Department of Polytrauma, Nizhniy Novgorod Regional Hospital named after N.A. Semashko, 190, Rodionov Str., Nizhniy Novgorod, 603126, Russia

    Darya Agarkova & Svetlana Trofimova

Authors
  1. Alex O. Trofimov M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. George Kalentyev
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Oleg Voennov
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michail Yuriev
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Darya Agarkova
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Svetlana Trofimova
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vera Grigoryeva
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alex O. Trofimov M.D. .

Editor information

Editors and Affiliations

  1. Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA

    Thomas Heldt

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this paper

Cite this paper

Trofimov, A.O. et al. (2018). The Cerebrovascular Resistance in Combined Traumatic Brain Injury with Intracranial Hematomas. In: Heldt, T. (eds) Intracranial Pressure & Neuromonitoring XVI. Acta Neurochirurgica Supplement, vol 126. Springer, Cham. https://doi.org/10.1007/978-3-319-65798-1_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-65798-1_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-65797-4

  • Online ISBN: 978-3-319-65798-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation