title: Wartime traumatic cerebral vasospasm: recent review of combat casualties.
abstract: OBJECTIVE
  Blast-related neurotrauma is associated with the severest casualties from Operation Iraqi Freedom (OIF). A consequence of this is cerebral vasospasm. This study evaluated all inpatient neurosurgical consults related to battle injury from OIF.
  
  
  METHODS
  Evaluation of all admissions from OIF from April 2003 to October 2005 was performed on patients with neurotrauma and a diagnostic cerebral angiogram. Differences between patients with and without vasospasm and predictors of vasospasm were analyzed.
  
  
  RESULTS
  Fifty-seven out of 119 neurosurgical consults were evaluated. Of these, 47.4% had traumatic vasospasm; 86.7% of patients without vasospasm and 80.8% of patients with vasospasm sustained blast trauma. Average spasm duration was 14.3 days, with a range of up to 30 days. Vasospasm was associated with the presence of pseudoaneurysm (P = 0.05), hemorrhage (P = 0.03), the number of lobes injured (P = 0.012), and mortality (P = 0.029). Those with vasospasm fared worse than those without (P = 0.002). The number of lobes injured and the presence of pseudoaneurysm were significant predictors of vasospasm (P = 0.016 and 0.02, respectively). There was a significant quadratic trend towards neurological improvement for those receiving aggressive open surgical treatment (P = 0.002). In the vasospasm group, angioplasty with microballoon significantly lowered middle cerebral artery and basilar blood-flow velocities(P = 0.046 and 0.026, respectively).
  
  
  CONCLUSIONS
  Traumatic vasospasm occurred in a substantial number of patients with severe neurotrauma, and clinical outcomes were worse for those with this condition. However, aggressive open surgical and endovascular treatment strategies may have improved outcome. This was the first study to analyze the effects of blast-related injury on the cerebral vasculature.
authors.affiliation: Department of Neurosurgery, National Naval Medical Center, Bethesda, Maryland 20814, USA. RAArmonda@bethesda.med.navy.mil
authors.forename: Rocco A
authors.initials: RA
authors.lastname: Armonda
authors.forename: Randy S
authors.initials: RS
authors.lastname: Bell
authors.forename: Alexander H
authors.initials: AH
authors.lastname: Vo
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Ling
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: DeGraba
authors.forename: Benjamin
authors.initials: B
authors.lastname: Crandall
authors.forename: James
authors.initials: J
authors.lastname: Ecklund
authors.forename: William W
authors.initials: WW
authors.lastname: Campbell
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D007493:Iraq; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D020301:Vasospasm, Intracranial / Q000453:epidemiology* / Q000601:surgery*; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000601:surgery*