Skip to main content
SpringerLink
Log in

Quantitative cerebral blood flow and metabolism determination in the first 48 hours after severe head injury with a new dynamic spect device

  • Clinical Articles
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

Objective

To determine cerebral blood flow (CBF) and metabolism in the acute phase after severe head injury by a new dynamic SPECT device using133Xenon and to evaluate a possible role of CBF and metabolism in the determination of prognosis.

Design

Prospective study

Setting

General intensive care unit in a universitary teaching hospital

Subjects

23 severely head injured patients having CT scan and CBF determination, intracranial pressure (ICP) and jugular bulb oxygen saturation monitoring in the first 48 hours.

Measurements and main results

CBF varied from 18.0 to 60.0 ml/100 g/min. No correlation was found between early CBF and severity of trauma evaluated with the Glasgow Coma Score (GCS) (F = 2.151, p = 0.142) and between CBF and prognosis at 6 months evaluated with Glasgow outcome score (GOS) (F = 0.491, p = 0.622; rs = 0.251, p = 0.246). CMRO2 was depressed in relation to the severity of injury, specifically ranging from 0.9±0.5 ml/ 100 g/min in patients with GCS 3 to 1.7 ±0.8 ml/100 g/min in patients with GCS 6–7. In no patient with a CMRO2 less than 0.8 ml/100 g/min was a good outcome observed. A significant correlation was found between GCS and GOS (rs = 0.699, p = 0.0002), between CMRO2 and GOS (F = 4.303, p = 0.031; rs = 0.525, p = 0.013) and between AJDO2 and GOS (F = 3.602, p = 0.046; rs = 0.491, p = 0.017). Fronto-occipital ratio (F/O) of CBF distribution was significantly lower than normal values (χ2=18.658, p = 0.001) but did not correlate either with prognosis (χ2 = 1.626, p = 0.443) or with severity (χ2 = 1.913, p = 0.384).

Conclusions

CBF in the first 48 hours after trauma varies within a large range of values and is not correlated with severity and prognosis. Clinical evaluation with GCS and CMRO2 are much more reliable indicators of severity of head trauma and have a significant role in the determination of prognosis. F/O ration is significantly altered from normal values confirming “post-traumatic hypofrontalism” but does not correlate with severity and prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Abdel Dajem HM, Sadek SA, Kouris K,et al (1987) Changes in cerebral perfusion after acute head injury: comparison of CT with Tc-99m HM-PAO SPECT. Radiology 165: 221–229

    PubMed  Google Scholar 

  2. Bouma GJ, Muizelaar JP, Choi SC, Newton PG, Young HF (1991) Cerebral circulation and metabolism after severe traumatic injury: the elusive role of ischemia. J Neurosurg 75: 685–693

    PubMed  Google Scholar 

  3. Celsis P, Goldman T (1981) A method for calculating regional cerebral blood flow from emission computed tomography of inert gas concentration. J Comput Assist Tomogr 5: 641–645

    PubMed  Google Scholar 

  4. Chesnut RM, Marshall LF, Klauber MR,et al (1993) The role of secondary brain injury in determining outcome from severe head injury. J Trauma 34: 216–222

    PubMed  Google Scholar 

  5. Clifton GL, Siegler MG, Gossmann RG (1981) Circulating catecholamines and sympathetic activity after head injuries. Davis, Philadelphia, pp 228–229

    Google Scholar 

  6. Cold GE (1990) Cerebral blood flow in acute head injury. Acta Neurochir (Wien) [Suppl] 49: 1–64

    Google Scholar 

  7. De Rossi G (1992) A new cerebral tomograph: technical features and preliminary experience. Rad Diag 33: 236–240

    Google Scholar 

  8. Deutch G, Eisenberg HM (1987) Frontal blood flow changes in recovery from coma. J Cereb Blood Flow Metab 7: 29–34

    PubMed  Google Scholar 

  9. Eisenberg HM, Cayard C, Papanicolau AC,et al (1983) The effect of three potentially preventable complications on outcome after severe closed head injury In: Ishii S, Nagai H, Brock M (eds) Intracranial pressure V. Springer, Berlin Heidelberg New York Tokyo, pp 549–553

    Google Scholar 

  10. Feldman Z, Narayan RK, Robertson CS (1992) Secondary insults associated with severe closed head injury. Contemp Neurosurg 14: 1–8

    Google Scholar 

  11. Giordano A, Calcagni ML, Di Fazio P, Della Corte F, Barelli A, Pennisi MA, Sada E, Colombo S, Galli G (1991) Brain Spet (99mTc-HMPAO) and DSPET (133Xenon) using a new fast rotating 28 slices cerebral tomograph. In: Schmidt HA, Hofer R (eds) Nuclear medicine in research and practice. Schattauer, Stuttgart, pp 6–8

    Google Scholar 

  12. Hemmer M (1988) Factors influencing outcome after severe head trauma. In: Vincent JL (ed) Update in intensive care and emergency medicine, Vol 5. Update. Springer, Berlin Heidelberg New York Tokyo, pp 537–544

    Google Scholar 

  13. Jaggi JL, Obrist WD, Gennarelli TA,et al (1990) Relationship of early cerebral blood flow and metabolism to outcome in acute head injury. J Neurosurg 72: 176–182

    PubMed  Google Scholar 

  14. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet 1: 480–484

    PubMed  Google Scholar 

  15. Kanno I, Lassen NA (1979) Two methods for calculating cerebral blood flow from emission computed tomography of inert gas concentration. J Comput Assist Tomogr 3: 71–76

    PubMed  Google Scholar 

  16. Langfitt TW, Obrist WD (1981) Cerebral blood flow and metabolism after intracranial trauma. Prog Neurol Surg 10: 14–48

    Google Scholar 

  17. Lassen NA, Ingvar DH, Skinhoj E (1978) Brain function and blood flow. SCI AM 239: 62

    Google Scholar 

  18. Messeter K, Nordstroem CH, Sundbarg G, Algotsson L, Ryding E (1986) Cerebral hemodynamics in patients with severe head trauma. J Neurosurg 64: 231–237

    PubMed  Google Scholar 

  19. Miller JD, Sweet RC, Narayan RK, Becker DP (1978) Early insults in the injured brain. JAMA 24(5): 439–441

    Google Scholar 

  20. Miller JD (1985) Head injury and brain ischemia — implications for therapy. Br J Anesth 7: 120–129

    Google Scholar 

  21. Miller JD, Becker DP, Ward JD,et al (1977) Significance of intracranial hypertension in severe head injury. J Neurosurg 47: 503–516

    PubMed  Google Scholar 

  22. Miller JD, Garibi J, North JB (1975) Effects of increased arterial pressure on blood flow in the damaged brain. J Neurol Neurosurg Psychiatry 38: 657–665

    PubMed  Google Scholar 

  23. Muizelaar JP (1989) Cerebral blood flow, cerebral blood volume and cerebral metabolism after severe head injury. In: Becker DP, Gudeman SK (eds) Textbook of head injury. Saunders

  24. Muizelaar JP, Ward JD, Marmarou A,et al (1989) Cerebral blood flow and metabolism in severely head-injured children. Part 1: Relation with GCS, outcome, ICP and PVI. J Neurosurg 71: 63–71

    PubMed  Google Scholar 

  25. Obrist WD, Gennarelli TA, Segawa A (1979) Relation of cerebral blood flow to neurological status and outcome in head-injured patients. J Neurosurg 51: 292–300

    PubMed  Google Scholar 

  26. Obrist WD, Langfitt TW, Jaggi JL,et al (1984) Cerebral blood flow and metabolism in comatose patients with acute head injury. Relationship to intracranial hypertension. J Neurosurg 61: 241–253

    PubMed  Google Scholar 

  27. Oder W, Goldenberg G, Podreka I, Deecke L (1991) HM-PAO-SPECT in persistent vegetative state after head injury: prognostic indicator of the likelihood of recovery? Intensive Care Med 17: 149–153

    PubMed  Google Scholar 

  28. Ommaya AK, Gennarelli TA (1975) A physiopathologic basis for noninvasive diagnosis and prognosis of head injury severity. In: McLaurin L (ed) Proceedings of the second Chicago symposium on neural trauma. Grune and Stratton, New York

    Google Scholar 

  29. Overgaard J, Mosdal C, Tweed WA (1981) Cerebral circulation after head injury. Part 3: Dose regional cerebral flow determine recovery of brain function after blunt head injury? J Neurosurg 55: 63–74

    PubMed  Google Scholar 

  30. Overgaard J, Tweed WA (1974) Cerebral circulation after head injury. Part 1: Cerebral blood flow and its regulation after closed head injury with emphasis on clinical correlations. J Neurosurg 41: 531–541

    PubMed  Google Scholar 

  31. Pfenniger EG, Lindner KH (1991) Arterial blood gases in patients with acute head injury at the incident side and upon hospital admission. Acta Anesth Scand 35(22): 148–152

    Google Scholar 

  32. Robertson CS, Clifton GL, Taylor AA (1983) Treatment of hypertension associated with head injury. J Neurosurg 59: 455

    PubMed  Google Scholar 

  33. Roine RO, Launes J, Nikkinen P, Lindroth L, Kaste M (1991) Regional cerebral blood flow after human cardiac arrest. Arch Neurol 48: 625–629

    PubMed  Google Scholar 

  34. Roper SN, Mena I, King WA,et al (1991) An analysis of cerebral blood flow in acute closed-head injury using technetium-99-m-HMPAO SPECT and computed tomography. J Nucl Med 32: 1684–1687

    PubMed  Google Scholar 

  35. Sato M, Kuroda R, Ioku M, Kim A, Tanaka S,et al (1989) Regional cerebral blood flow in the persistent vegetative state. Neurol Med Chir (Tokyo) 29: 389–394

    Google Scholar 

  36. Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2: 81–84

    PubMed  Google Scholar 

  37. Uzzell BP, Obrist WD, Dolinkas CA, Langfitt TW (1986) Relationship of acute CBF and ICP findings to neuropsychological outcome in severe head injury. J Neurosurg 65: 630–635

    PubMed  Google Scholar 

  38. Yoshino E, Yamaki T, Higuchi T,et al (1985) Acute brain edema in fatal head injury: analysis by dynamic CT scanning. J Neurosurg 63: 830–839

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy

    F. Della Corte M.D., M. A. Pennisi, A. Barelli & A. Caricato

  2. Department of Nuclear Medicine, Catholic University School of Medicine, Rome, Italy

    A. Giordano & G. Galli

  3. Department of Radiology, Catholic University School of Medicine, Rome, Italy

    P. Campioni

Authors
  1. F. Della Corte M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Giordano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. A. Pennisi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Barelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Caricato
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Campioni
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G. Galli
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Corte, F.D., Giordano, A., Pennisi, M.A. et al. Quantitative cerebral blood flow and metabolism determination in the first 48 hours after severe head injury with a new dynamic spect device. Acta neurochir 139, 636–642 (1997). https://doi.org/10.1007/BF01411999

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01411999

Keywords

Search

Navigation