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Hyperemia in head injury: can transcranial doppler help to personalize therapies for intracranial hypertension?

INTRODUCTION: An increase in cerebral blood flow is frequent after traumatic brain injury (TBI) and can lead to brain swelling and refractory intracranial hypertension. We hypothesized that Transcranial EcoDoppler (TCD) monitoring could be useful to detect the cause of intracranial hypertension in t...

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Autores principales: Gelormini, Camilla, Ioannoni, Eleonora, Scavone, Angela, Pisapia, Luca, Signorelli, Francesco, Montano, Nicola, Piastra, Marco, Caricato, Anselmo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10686491/
https://www.ncbi.nlm.nih.gov/pubmed/38033776
http://dx.doi.org/10.3389/fneur.2023.1259180
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author Gelormini, Camilla
Ioannoni, Eleonora
Scavone, Angela
Pisapia, Luca
Signorelli, Francesco
Montano, Nicola
Piastra, Marco
Caricato, Anselmo
author_facet Gelormini, Camilla
Ioannoni, Eleonora
Scavone, Angela
Pisapia, Luca
Signorelli, Francesco
Montano, Nicola
Piastra, Marco
Caricato, Anselmo
author_sort Gelormini, Camilla
collection PubMed
description INTRODUCTION: An increase in cerebral blood flow is frequent after traumatic brain injury (TBI) and can lead to brain swelling and refractory intracranial hypertension. We hypothesized that Transcranial EcoDoppler (TCD) monitoring could be useful to detect the cause of intracranial hypertension in these patients. Our main objective was to investigate if the increase of velocity in the middle cerebral artery (MCA) on TCD could be associated with intracranial hypertension. METHODS: We retrospectively studied TBI patients consecutively monitored with TCD. Hyperemia was defined as MCA mean velocity higher than 80 cm/s. Intracranial hypertension was considered when hyperosmolar therapy, hyperventilation, or deep sedation was used. RESULTS: We found hyperemia in 40 patients out of 118 (33.9%). On average, it started at day 2.1 ± 0.9 from admission and significantly increased (MCA velocity at day 1: 74 ± 25 cm/s vs. 109 ± 36 cm/s at day 4; p < 0.001). Intracranial hypertension was significantly associated with hyperemia, occurring in 92.5% of hyperemic and 51.3% of non-hyperemic patients (p < 0.001). Moreover, we found that hyperemia preceded severe intracranial hypertension (p < 0.0001). In a logistic regression model, hyperemia was the only variable significantly correlated with intracranial hypertension (OR 10.64; p < 0.001). DISCUSSION: Hyperemia was frequent in our population of TBI patients and preceded intracranial hypertension. TCD monitoring, if performed on a daily regular basis, can be a useful method to detect this phenomenon and to guide the therapy. It could be a tool for a cause-oriented therapy of intracranial hypertension.
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spelling pubmed-106864912023-11-30 Hyperemia in head injury: can transcranial doppler help to personalize therapies for intracranial hypertension? Gelormini, Camilla Ioannoni, Eleonora Scavone, Angela Pisapia, Luca Signorelli, Francesco Montano, Nicola Piastra, Marco Caricato, Anselmo Front Neurol Neurology INTRODUCTION: An increase in cerebral blood flow is frequent after traumatic brain injury (TBI) and can lead to brain swelling and refractory intracranial hypertension. We hypothesized that Transcranial EcoDoppler (TCD) monitoring could be useful to detect the cause of intracranial hypertension in these patients. Our main objective was to investigate if the increase of velocity in the middle cerebral artery (MCA) on TCD could be associated with intracranial hypertension. METHODS: We retrospectively studied TBI patients consecutively monitored with TCD. Hyperemia was defined as MCA mean velocity higher than 80 cm/s. Intracranial hypertension was considered when hyperosmolar therapy, hyperventilation, or deep sedation was used. RESULTS: We found hyperemia in 40 patients out of 118 (33.9%). On average, it started at day 2.1 ± 0.9 from admission and significantly increased (MCA velocity at day 1: 74 ± 25 cm/s vs. 109 ± 36 cm/s at day 4; p < 0.001). Intracranial hypertension was significantly associated with hyperemia, occurring in 92.5% of hyperemic and 51.3% of non-hyperemic patients (p < 0.001). Moreover, we found that hyperemia preceded severe intracranial hypertension (p < 0.0001). In a logistic regression model, hyperemia was the only variable significantly correlated with intracranial hypertension (OR 10.64; p < 0.001). DISCUSSION: Hyperemia was frequent in our population of TBI patients and preceded intracranial hypertension. TCD monitoring, if performed on a daily regular basis, can be a useful method to detect this phenomenon and to guide the therapy. It could be a tool for a cause-oriented therapy of intracranial hypertension. Frontiers Media S.A. 2023-11-15 /pmc/articles/PMC10686491/ /pubmed/38033776 http://dx.doi.org/10.3389/fneur.2023.1259180 Text en Copyright © 2023 Gelormini, Ioannoni, Scavone, Pisapia, Signorelli, Montano, Piastra and Caricato. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Gelormini, Camilla
Ioannoni, Eleonora
Scavone, Angela
Pisapia, Luca
Signorelli, Francesco
Montano, Nicola
Piastra, Marco
Caricato, Anselmo
Hyperemia in head injury: can transcranial doppler help to personalize therapies for intracranial hypertension?
title Hyperemia in head injury: can transcranial doppler help to personalize therapies for intracranial hypertension?
title_full Hyperemia in head injury: can transcranial doppler help to personalize therapies for intracranial hypertension?
title_fullStr Hyperemia in head injury: can transcranial doppler help to personalize therapies for intracranial hypertension?
title_full_unstemmed Hyperemia in head injury: can transcranial doppler help to personalize therapies for intracranial hypertension?
title_short Hyperemia in head injury: can transcranial doppler help to personalize therapies for intracranial hypertension?
title_sort hyperemia in head injury: can transcranial doppler help to personalize therapies for intracranial hypertension?
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10686491/
https://www.ncbi.nlm.nih.gov/pubmed/38033776
http://dx.doi.org/10.3389/fneur.2023.1259180
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