Posttraumatic vasospasm detected by continuous brain tissue oxygen monitoring: Treatment with intraarterial verapamil and balloon angioplasty

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26 Citations (Scopus)

Abstract

Introduction: Posttraumatic vasospasm (PTV) is a relatively common event following traumatic brain injury (TBI) that has been strongly correlated with worse neurological outcome in many studies. However, vasospasm continues to be an under-recognized source of secondary injury following TBI, and currently published guidelines do not address screening or management strategies for PTV. Brain tissue oxygen (PbtO2) monitoring probes allow for continuous screening for cerebral hypoxia following TBI, but their use as a monitor for PTV has not been previously described. Methods: Case report and literature review. Results: We present a case of PTV identified by persistent low PbtO2 despite aggressive medical therapy. Computed tomography and digital subtraction angiography confirmed severe cerebral arterial vasospasm involving both anterior and posterior circulations. The patient was successfully treated with serial intraarterial therapy including balloon angioplasty and verapamil infusion. Conclusion: Posttraumatic vasospasm should be included in the differential diagnosis of cerebral hypoxia (e.g., low PbtO2) following TBI. Management strategies for PTV may include early, aggressive intraarterial therapies including drug infusion and balloon angioplasty.

Original languageEnglish (US)
Pages (from-to)61-69
Number of pages9
JournalNeurocritical Care
Volume10
Issue number1
DOIs
StatePublished - Feb 2009

Fingerprint

Balloon Angioplasty
Verapamil
Oxygen
Brain Hypoxia
Brain
Intracranial Vasospasm
Digital Subtraction Angiography
Therapeutics
Differential Diagnosis
Tomography
Guidelines
Drug Therapy
Traumatic Brain Injury
Wounds and Injuries

Keywords

  • Angioplasty
  • Brain tissue oxygen
  • PO
  • Traumatic brain injury
  • Vasospasm
  • Verapamil

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

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title = "Posttraumatic vasospasm detected by continuous brain tissue oxygen monitoring: Treatment with intraarterial verapamil and balloon angioplasty",
abstract = "Introduction: Posttraumatic vasospasm (PTV) is a relatively common event following traumatic brain injury (TBI) that has been strongly correlated with worse neurological outcome in many studies. However, vasospasm continues to be an under-recognized source of secondary injury following TBI, and currently published guidelines do not address screening or management strategies for PTV. Brain tissue oxygen (PbtO2) monitoring probes allow for continuous screening for cerebral hypoxia following TBI, but their use as a monitor for PTV has not been previously described. Methods: Case report and literature review. Results: We present a case of PTV identified by persistent low PbtO2 despite aggressive medical therapy. Computed tomography and digital subtraction angiography confirmed severe cerebral arterial vasospasm involving both anterior and posterior circulations. The patient was successfully treated with serial intraarterial therapy including balloon angioplasty and verapamil infusion. Conclusion: Posttraumatic vasospasm should be included in the differential diagnosis of cerebral hypoxia (e.g., low PbtO2) following TBI. Management strategies for PTV may include early, aggressive intraarterial therapies including drug infusion and balloon angioplasty.",
keywords = "Angioplasty, Brain tissue oxygen, PO, Traumatic brain injury, Vasospasm, Verapamil",
author = "Kiarash Shahlaie and Boggan, {James E} and Latchaw, {Richard E} and Cheng Ji and Muizelaar, {Jan Paul}",
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T2 - Treatment with intraarterial verapamil and balloon angioplasty

AU - Shahlaie, Kiarash

AU - Boggan, James E

AU - Latchaw, Richard E

AU - Ji, Cheng

AU - Muizelaar, Jan Paul

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N2 - Introduction: Posttraumatic vasospasm (PTV) is a relatively common event following traumatic brain injury (TBI) that has been strongly correlated with worse neurological outcome in many studies. However, vasospasm continues to be an under-recognized source of secondary injury following TBI, and currently published guidelines do not address screening or management strategies for PTV. Brain tissue oxygen (PbtO2) monitoring probes allow for continuous screening for cerebral hypoxia following TBI, but their use as a monitor for PTV has not been previously described. Methods: Case report and literature review. Results: We present a case of PTV identified by persistent low PbtO2 despite aggressive medical therapy. Computed tomography and digital subtraction angiography confirmed severe cerebral arterial vasospasm involving both anterior and posterior circulations. The patient was successfully treated with serial intraarterial therapy including balloon angioplasty and verapamil infusion. Conclusion: Posttraumatic vasospasm should be included in the differential diagnosis of cerebral hypoxia (e.g., low PbtO2) following TBI. Management strategies for PTV may include early, aggressive intraarterial therapies including drug infusion and balloon angioplasty.

AB - Introduction: Posttraumatic vasospasm (PTV) is a relatively common event following traumatic brain injury (TBI) that has been strongly correlated with worse neurological outcome in many studies. However, vasospasm continues to be an under-recognized source of secondary injury following TBI, and currently published guidelines do not address screening or management strategies for PTV. Brain tissue oxygen (PbtO2) monitoring probes allow for continuous screening for cerebral hypoxia following TBI, but their use as a monitor for PTV has not been previously described. Methods: Case report and literature review. Results: We present a case of PTV identified by persistent low PbtO2 despite aggressive medical therapy. Computed tomography and digital subtraction angiography confirmed severe cerebral arterial vasospasm involving both anterior and posterior circulations. The patient was successfully treated with serial intraarterial therapy including balloon angioplasty and verapamil infusion. Conclusion: Posttraumatic vasospasm should be included in the differential diagnosis of cerebral hypoxia (e.g., low PbtO2) following TBI. Management strategies for PTV may include early, aggressive intraarterial therapies including drug infusion and balloon angioplasty.

KW - Angioplasty

KW - Brain tissue oxygen

KW - PO

KW - Traumatic brain injury

KW - Vasospasm

KW - Verapamil

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