Cerebral autoregulation following minor head injury.
The purpose of this study was to determine whether patients with minor head injury experience impairments in cerebral autoregulation. Twenty-nine patients with minor head injuries defined by Glasgow Coma Scale (GCS) scores of 13 to 15 underwent testing of dynamic cerebral autoregulation within 48 hours of their injury using continuous transcranial Doppler velocity recordings and blood pressure recordings. Twenty-nine age-matched normal volunteers underwent autoregulation testing in the same manner to establish comparison values. The function of the autoregulatory response was assessed by the cerebral blood flow velocity response to induced rapid brief changes in arterial blood pressure and measured as the autoregulation index (ARI). Eight (28%) of the 29 patients with minor head injury demonstrated poorly functioning or absent cerebral autoregulation versus none of the controls, and this difference was highly significant (p = 0.008). A significant correlation between lower blood pressure and worse autoregulation was found by regression analysis in head-injured patients (r = 0.6, p < 0.001); however, lower blood pressure did not account for the autoregulatory impairment in all patients. Within this group of head-injured patients there was no correlation between ARI and initial GCS or 1-month Glasgow Outcome Scale scores. This study indicates that a significant number of patients with minor head injury may have impaired cerebral autoregulation and may be at increased risk for secondary ischemic neuronal damage.
Jünger
E C
EC
Department of Neurological Surgery, School of Medicine, University of Washington, Seattle, USA.
Newell
D W
DW
Grant
G A
GA
Avellino
A M
AM
Ghatan
S
S
Douville
C M
CM
Lam
A M
AM
Aaslid
R
R
Winn
H R
HR
D000293:Adolescent; D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D001794:Blood Pressure; D001924:Brain Concussion / Q000000981:diagnostic imaging / Q000503:physiopathology; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002545:Brain Ischemia / Q000209:etiology; D016022:Case-Control Studies; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D005260:Female; D015600:Glasgow Coma Scale; D006706:Homeostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012044:Regression Analysis; D012307:Risk Factors; D012887:Skull Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology; D017585:Ultrasonography, Doppler, Transcranial; D014655:Vascular Resistance