scholarly journals Characterization of cerebral hemodynamic phases following severe head trauma: hypoperfusion, hyperemia, and vasospasm

1997 ◽  
Vol 2 (5) ◽  
pp. E2
Author(s):  
Neil A. Martin ◽  
Ravish V. Patwardhan ◽  
Michael J. Alexander ◽  
Cynthia Zane Africk ◽  
Jae Hong Lee ◽  
...  
Keyword(s):  
Head Trauma ◽  
Craniocerebral Trauma ◽  
Phase Iii ◽  
Severe Head Trauma ◽  
Cerebral Hemodynamic ◽  
Normal Mean ◽  
Time Courses ◽  
Oxygen Difference ◽  
Severe Craniocerebral Trauma

The extent and timing of posttraumatic cerebral hemodynamic disturbances have significant implications for the monitoring and treatment of patients with head injury. This prospective study of cerebral blood flow (CBF) (measured using 133Xe clearance) and transcranial Doppler (TCD) measurements in 125 patients with severe head trauma has defined three distinct hemodynamic phases during the first 2 weeks after injury. The phases are further characterized by measurements of cerebral arteriovenous oxygen difference (AVDO2) and cerebral metabolic rate of oxygen (CMRO2). Phase I (hypoperfusion phase) occurs on the day of injury (Day 0) and is defined by a low CBF15 calculated from cerebral clearance curves integrated to 15 minutes (mean CBF15 32.3 ± 2 ml/100 g/minute), normal middle cerebral artery (MCA) velocity (mean VMCA 56.7 ± 2.9 cm/second), normal hemispheric index (mean HI 1.67 ± 0.11), and normal AVDO2 (mean AVDO2 5.4 ± 0.5 vol%). The CMRO2 is approximately 50% of normal (mean CMRO2 1.77 ± 0.18 ml/100 g/minute) during this phase and remains depressed during the second and third phases. In Phase II (hyperemia phase, Days 1-3), CBF increases (46.8 ± 3 ml/100 g/minute), AVDO2 falls (3.8 ± 0.1 vol%), VMCA velocity rises (86 ± 3.7 cm/second), and the HI remains less than 3 (2.41 ± 0.1). In Phase III (vasospasm phase, Days 4-15), there is a fall in CBF (35.7 ± 3.8 ml/100 g/minute), a further increase in VMCA (96.7 ± 6.3 cm/second), and a pronounced rise in the HI (2.87 ± 0.22). This is the first study in which CBF, metabolic, and TCD measurements are combined to define the characteristics and time courses of, and to suggest etiological factors for, the distinct cerebral hemodynamic phases that occur after severe craniocerebral trauma. This research is consistent with and builds on the findings of previous investigations and may provide a useful temporal framework for the organization of existing knowledge regarding posttraumatic cerebrovascular and metabolic pathophysiology.

Characterization of cerebral hemodynamic phases following severe head trauma: hypoperfusion, hyperemia, and vasospasm

1997 ◽  
Vol 87 (1) ◽  
pp. 9-19 ◽  
Author(s):  
Neil A. Martin ◽  
Ravish V. Patwardhan ◽  
Michael J. Alexander ◽  
Cynthia Zane Africk ◽  
Jae Hong Lee ◽  
...  
Keyword(s):  
Head Trauma ◽  
Craniocerebral Trauma ◽  
Phase Iii ◽  
Severe Head Trauma ◽  
Content Type ◽  
Cerebral Hemodynamic ◽  
Normal Mean ◽  
Time Courses ◽  
Fine Print

✓ The extent and timing of posttraumatic cerebral hemodynamic disturbances have significant implications for the monitoring and treatment of patients with head injury. This prospective study of cerebral blood flow (CBF) (measured using 133Xe clearance) and transcranial Doppler (TCD) measurements in 125 patients with severe head trauma has defined three distinct hemodynamic phases during the first 2 weeks after injury. The phases are further characterized by measurements of cerebral arteriovenous oxygen difference (AVDO2) and cerebral metabolic rate of oxygen (CMRO2). Phase I (hypoperfusion phase) occurs on the day of injury (Day 0) and is defined by a low CBF15 calculated from cerebral clearance curves integrated to 15 minutes (mean CBF15 32.3 ± 2 ml/100 g/minute), normal middle cerebral artery (MCA) velocity (mean VMCA 56.7 ± 2.9 cm/second), normal hemispheric index ([HI], mean HI 1.67 ± 0.11), and normal AVDO2 (mean AVDO2 5.4 ± 0.5 vol%). The CMRO2 is approximately 50% of normal (mean CMRO2 1.77 ± 0.18 ml/100 g/minute) during this phase and remains depressed during the second and third phases. In Phase II (hyperemia phase, Days 1–3), CBF increases (46.8 ± 3 ml/100 g/minute), AVDO2 falls (3.8 ± 0.1 vol%), VMCA rises (86 ± 3.7 cm/second), and the HI remains less than 3 (2.41 ± 0.1). In Phase III (vasospasm phase, Days 4–15), there is a fall in CBF (35.7 ± 3.8 ml/100 g/minute), a further increase in VMCA (96.7 ± 6.3 cm/second), and a pronounced rise in the HI (2.87 ± 0.22). This is the first study in which CBF, metabolic, and TCD measurements are combined to define the characteristics and time courses of, and to suggest etiological factors for, the distinct cerebral hemodynamic phases that occur after severe craniocerebral trauma. This research is consistent with and builds on the findings of previous investigations and may provide a useful temporal framework for the organization of existing knowledge regarding posttraumatic cerebrovascular and metabolic pathophysiology.

Primary End Points in Phase III Clinical Trials of Severe Head Trauma: DRS Versus GOS

1998 ◽  
Vol 15 (10) ◽  
pp. 771-776 ◽  
Author(s):  
SUNG C. CHOI ◽  
ANTHONY MARMAROU ◽  
ROSS BULLOCK ◽  
JOHN S. NICHOLS ◽  
XIN WEI ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Head Trauma ◽  
Phase Iii ◽  
Severe Head Trauma ◽  
End Points ◽  
Phase Iii Clinical Trials

X-linked Adrenoleukodystrophy: Severe Head Trauma Masked Diagnosis—A Case Report

2014 ◽  
Vol 45 (S 01) ◽  
Author(s):  
E. Haber ◽  
M. Brunner-Krainz ◽  
W. Erwa ◽  
U. Gruber-Sedlmeyer ◽  
A. Schwerin-Nagel ◽  
...  
Keyword(s):  
Case Report ◽  
Head Trauma ◽  
Severe Head Trauma

scholarly journals 243 Jugular Bulb Metabolic Data within First 12-Hours After Severe Head Trauma

1993 ◽  
Vol 8 (S3) ◽  
pp. S128-S129
Author(s):  
C.S De Deyne ◽  
J.M Decruyenaere ◽  
J.I Poelaert ◽  
F.A Colardyn
Keyword(s):  
Head Trauma ◽  
Jugular Bulb ◽  
Severe Head Trauma ◽  
Metabolic Data

Client-Centered Emergency Care

1981 ◽  
Vol 2 (6) ◽  
pp. 1-4
Author(s):  
Jennifer MacPherson
Keyword(s):  
Emergency Room ◽  
Head Trauma ◽  
Emergency Care ◽  
Severe Head Trauma ◽  
Best Interest ◽  
Motorcycle Accident ◽  
Florence Nightingale ◽  
Centered Care ◽  
Patient Emergency

Since Florence Nightingale, nurses have agreed that care should be individualized for each patient. Emergency care is no different and texts on this subject instruct the nurse to involve the client in his own care and to recognize that being an emergency victim is physically and psychologically difficult for the client. But just what is client-centered emergency care and are clients getting it?A client is brought to the emergency room, unconscious, with severe head trauma resulting from a motorcycle accident. In this instance client-centered care consists of the nurse reacting swiftly and probably unemotionally. It is not in the client's best interest at this time for the nurse to try to ascertain that person's values and life views. Here client-centered care is compatible with the values and views of both the nurse and the institution.

Thermal decomposition of multilayer honeycomb core laminate sandwich composite panels in cone calorimeter apparatus – Effect of the top decomposed layer

2021 ◽  
pp. 002199832199087
Author(s):  
Hussain Najmi ◽  
Jocelyn Luche ◽  
Thomas Rogaume
Keyword(s):  
Cone Calorimeter ◽  
Single Layer ◽  
Heat Fluxes ◽  
Decomposition Process ◽  
Phase Iii ◽  
Sandwich Composite ◽  
Back Surface ◽  
Multilayer Composite ◽  
In Fire

Multilayer composite materials are frequently used in aircraft interiors. Even though they have high properties (such as physical, chemical and mechanical properties), their application is limited due to lack of knowledge of their decomposition process and on the interaction between different layers in fire. In the present work, two types of composites with 3 and 4 layers are studied. The fire characterization of multilayer composite is studied in 3 different phases using ISO-5660 cone calorimeter at two heat fluxes (35 and 50 kW.m−2). Phase-I mainly concentrates on the decomposition of single layer materials (paint, laminate and honeycomb) while in phase-II and phase-III, different assemblies are formed using a single layer material and studied in the same experimental configuration. In all the three phases, back surface temperatures of the materials or assemblies are measured and analyzed with different gas productions which allow to understand the dynamics of the decomposition process. The finding from the cone calorimeter study suggests that the ignition primarily depends on the top layer behavior of the composite. The permeability analysis on the top layer of the composite confirms that decomposed layer of paint offers more resistance to the volatile gases escaping from the composite. At the end of the study, thermal conductivity is determined and the ignition temperature of both the composite is determined.

Pneumocephalus Following Severe Head Trauma

2008 ◽  
Vol 35 (2) ◽  
pp. 186-189
Author(s):  
Dennis E. J. G. J. Dolmans ◽  
Maurice A. A. J. van den Bosch ◽  
Lino Ramos ◽  
Loek P. H. Leenen
Keyword(s):  
Head Trauma ◽  
Severe Head Trauma

Diffuse Axonal Injury in Infants With Nonaccidental Craniocerebral Trauma

1999 ◽  
Vol 123 (2) ◽  
pp. 146-151 ◽  
Author(s):  
Aaron M. Gleckman ◽  
Michael D. Bell ◽  
Richard J. Evans ◽  
Thomas W. Smith
Keyword(s):  
Head Trauma ◽  
Axonal Injury ◽  
Diffuse Axonal Injury ◽  
Craniocerebral Trauma ◽  
Shaken Baby Syndrome ◽  
Normal Brain ◽  
Accurate Identification ◽  
Blunt Head Trauma ◽  
Hematoxylin Eosin ◽  
Axonal Swellings

Abstract Objective.—Accurate identification of diffuse axonal injury is important in the forensic investigation of infants who have died from traumatic brain injury. β-Amyloid precursor protein (β-APP) immunohistochemical staining is highly sensitive in identifying diffuse axonal injury. However, the effectiveness of this method in brain-injured infants has not been well established. The present study was undertaken to assess the utility of β-APP immunohistochemistry in detecting diffuse axonal injury in infants with either shaken baby syndrome or blunt head trauma. Materials and Methods.—Archival formalin-fixed, paraffin-embedded blocks from infants (<1 year old) with shaken baby syndrome (7 cases) and blunt head trauma (3) and blocks from 7 control cases that included nontraumatic cerebral edema (1), acute hypoxic-ischemic encephalopathy (1), and normal brain (5) were immunostained for β-APP. A semiquantitative assessment of the severity of axonal staining was made. Corresponding hematoxylin-eosin–stained sections were examined for the presence of axonal swellings. Results.—Immunostaining for β-APP identified diffuse axonal injury in 5 of 7 infants with shaken baby syndrome and 2 of 3 infants with blunt head trauma. Immunoreactive axons were easily identified and were present in the majority of the sections examined. By contrast, hematoxylin-eosin staining revealed axonal swellings in only 3 of 7 infants with shaken baby syndrome and 1 of 3 infants with blunt head trauma. Most of these sections had few if any visible axonal swellings, which were often overlooked on initial review of the slides. No β-APP immunoreactivity was observed in any of the 7 control cases. Conclusions.—Immunostaining for β-APP can easily and reliably identify diffuse axonal injury in infants younger than 1 year and is considerably more sensitive than routine hematoxylin-eosin staining. We recommend its use in the forensic evaluation of infants with fatal craniocerebral trauma.

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