ORIGINAL ARTICLES   

Journal of Neurosurgical Sciences 2002 March;46(1):10-7

Copyright © 2002 EDIZIONI MINERVA MEDICA

lingua: Inglese

Hypoflow and hyperflow in diffuse axonal injury. Prognostic and therapeutic implications of transcranial. Doppler sonography evaluation

Visocchi M. ¹, Chiaretti A. ², Cabezas D. ¹, Meglio M. ¹

¹ Institute of Neurosurgery, Catholic University, Roma; ² Paediatric Intensive Care Unit, Institute of Paediatrics, Catholic University, Roma

Background. In the ­present ­report we ­describe the ­results of a ­study ­aimed at eval­u­at­ing the cere­bral hae­mod­y­nam­ics and the neu­ro­ra­dio­log­i­cal find­ings ­observ-ed in 7 con­sec­u­tive ­patients, 4 ­adults and 3 chil­dren (6, 8 and 10 ­years old), affect­ed by dif­fuse axo­nal inju­ry (DAI).
Methods. All the ­patients ­were admit­ted to the Paediatric or Adult Intensive Care Unit ­with GCS ­scores ­less ­than 8 ­after a ­severe ­brain inju­ry. Serial ­head CT ­scan and trans-cranial Doppler sonography (TCD) exam­ina­tions ­were car­ried out in all ­patients; MRI was car­ried out in the paed­i­at­ric ­patients ­only. TCD of the mid­dle cere­bral arter­ies was per­formed ­through the tem­po­ral ­bone win­dow. In 6 cas­es (2 paed­i­at­ric) diu­ret­ic osmot­ic ther­a­py was imme­di­ate­ly admin­is­tered and in 6 cas­es (3 paed­i­at­ric) bar­bit­u­rates and hyper­ven­ti­la­tion ­were ­also ­used.
Results. Hyperflow, var­i­ably respon­sive to bar­bit­u­rate ther­a­py of vasop­a­ral­y­sis, was ­observed in all paed­i­at­ric ­patients and in 3 ­adult sub­jects (85.7%: 6 out of 7 ­pa-tients) by ­means of TCD.
Conclusions. Observation of ­these phe­nom­e­na ­allowed us to mod­i­fy the phar­mac­o­log­i­cal treat­ment and/or per­form exter­nal cere­bro­spi­nal ­fluid (CSF) drain­age (­4 cas­es). Compartimental hyper­flow TCD pat­tern was evi­dent in 1 ­patient. Although the lim­it­ed num­ber of ­patients in our ­series ­does not ­allow defin­i­tive con­clu­sions, we strong­ly ­believe ­that TCD mon­i­tor­ing is an use­ful ­tool in plan­ning sur­gi­cal strat­e­gy in ­patients ­with DAI.