Early parenchymal contrast extravasation predicts subsequent hemorrhage progression, Clinical deterioration, and need for surgery in patients with traumatic cerebral contusion

Abel Po Hao Huang, Chung Wei Lee, Hong Jen Hsieh, Chi Cheng Yang, Yi Hsin Tsai, Fon Yih Tsuang, Lu Ting Kuo, Yuan Shen Chen, Yong Kwang Tu, Sheng Jean Huang, Hon Man Liu, Jui Chang Tsai

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: This study aimed to identify early radiologic signs that are predictive of hemorrhage progression and clinical deterioration in patients with traumatic cerebral contusion. We hypothesized that contrast extravasation (CE) and blood-brain barrier disruption might be associated with hemorrhage progression, brain edema, and clinical deterioration in these patients. Methods: Twenty-two patients with traumatic cerebral contusion (diagnosed on initial noncontrast head computed tomography [CT]) who initially did not require surgical intervention were enrolled in this study. Contrast-enhanced and perfusion CT scans were performed within 6 hours of injury, and follow-up noncontrast CT scans were performed at 24 hours and 72 hours. Results: In each noncontrast CT scan, the volumes of the contusion hemorrhage and edema were calculated using computerized planimetric techniques. The initial Glasgow Coma Scale, hemorrhage progression, clinical deterioration, and the need for subsequent surgery were recorded. The early radiologic findings were compared with these parameters and functional outcome at 6 months to identify predictive radiologic signs. CE was present in 9 of 22 patients (41%) and was highly associated with hemorrhage progression (p < 0.05), clinical deterioration (p < 0.01), and need for subsequent surgery (p < 0.01). In addition, patients with CE had a greater volume of edema at 24 hours (p < 0.01) and 72 hours (p < 0.01) than those who did not have CE. However, CE was not found to be associated with poor outcome. CONCLUSIONS: Early parenchymal CE is associated with hemorrhage progression, cerebral edema, clinical deterioration, and need for subsequent surgery. These patients should be monitored closely, and early surgery may be needed if deterioration occurs. Further elucidation of the pathophysiology is needed to formulate effective treatment for these high-risk patients.

Original languageEnglish
Pages (from-to)1593-1599
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume71
Issue number6
DOIs
Publication statusPublished - Dec 1 2011
Externally publishedYes

    Fingerprint

Keywords

  • Blood-brain barrier
  • Computed tomography
  • Contrast extravasation
  • Contusion
  • Head trauma
  • Perfusion

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this