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

13 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

Hemorrhage
Brain Edema
Tomography
Edema
Glasgow Coma Scale
Cone-Beam Computed Tomography
Contusions
Brain Contusion
Blood-Brain Barrier
Perfusion
Head
Wounds and Injuries
Therapeutics

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

Early parenchymal contrast extravasation predicts subsequent hemorrhage progression, Clinical deterioration, and need for surgery in patients with traumatic cerebral contusion. / Huang, Abel Po Hao; Lee, Chung Wei; Hsieh, Hong Jen; Yang, Chi Cheng; Tsai, Yi Hsin; Tsuang, Fon Yih; Kuo, Lu Ting; Chen, Yuan Shen; Tu, Yong Kwang; Huang, Sheng Jean; Liu, Hon Man; Tsai, Jui Chang.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 71, No. 6, 01.12.2011, p. 1593-1599.

Research output: Contribution to journalArticle

Huang, Abel Po Hao ; Lee, Chung Wei ; Hsieh, Hong Jen ; Yang, Chi Cheng ; Tsai, Yi Hsin ; Tsuang, Fon Yih ; Kuo, Lu Ting ; Chen, Yuan Shen ; Tu, Yong Kwang ; Huang, Sheng Jean ; Liu, Hon Man ; Tsai, Jui Chang. / Early parenchymal contrast extravasation predicts subsequent hemorrhage progression, Clinical deterioration, and need for surgery in patients with traumatic cerebral contusion. In: Journal of Trauma - Injury, Infection and Critical Care. 2011 ; Vol. 71, No. 6. pp. 1593-1599.
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T1 - Early parenchymal contrast extravasation predicts subsequent hemorrhage progression, Clinical deterioration, and need for surgery in patients with traumatic cerebral contusion

AU - Huang, Abel Po Hao

AU - Lee, Chung Wei

AU - Hsieh, Hong Jen

AU - Yang, Chi Cheng

AU - Tsai, Yi Hsin

AU - Tsuang, Fon Yih

AU - Kuo, Lu Ting

AU - Chen, Yuan Shen

AU - Tu, Yong Kwang

AU - Huang, Sheng Jean

AU - Liu, Hon Man

AU - Tsai, Jui Chang

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N2 - 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.

AB - 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.

KW - Blood-brain barrier

KW - Computed tomography

KW - Contrast extravasation

KW - Contusion

KW - Head trauma

KW - Perfusion

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