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Posttraumatic cerebral infarction in patients with moderate or severe head trauma

From the Institute of Anesthesiology-Intensive Care (R.M., D.M., P.G., N.L.) and Institute of Radiology (R.G., L.P., D.M.), Section of Neuroradiology, University of Brescia, Italy.

Address correspondence and reprint requests to Dr. N. Latronico, Institute of Anesthesiology-Intensive Care, University of Brescia, Piazzale Spedali Civili, 1-25125 Brescia, Italy; e-mail: latronic{at}med.unibs.it

Objective: To evaluate the frequency, types, and location of posttraumatic cerebral infarction, to assess if secondary cerebral insults were associated with cerebral infarction, and to determine if cerebral infarction affected patients' outcome.

Methods: We based diagnosis of cerebral infarction on review of brain CT scans. We assessed frequency of secondary cerebral insults, including intracranial hypertension, cerebral hypoperfusion, systolic hypo- and hypertension, arterial blood oxygen desaturation, hypocapnia, and hyperthermia, using clinical charts. We used the Glasgow Outcome Scale to evaluate outcome at 6 months after trauma.

Results: Of the 89 patients included, a total of 28 cerebral infarctions were found in 17 cases (19.1%). Infarctions were territorial in 23 (82.1%) and watershed in 5 (17.9%) cases. Territorial infarctions were localized to the middle cerebral artery (n = 9, 32.1%), lenticulostriate arteries (n = 6, 21.4%), posterior cerebral artery (n = 3, 10.7%), anterior cerebral artery (n = 3, 10.7%), thalamoperforating arteries (n = 1, 3.6%), and basilar artery (n = 1, 3.6%) territories. Watershed infarctions were in the boundary (n = 4, 14.3%) and terminal (n = 1, 3.6%) zones. Intracranial hypertension was the only independent variable predicting cerebral infarction (odds ratio [OR] 13.3; 95% CI 2.8 to 62.6). At 6 months after trauma, there was a lower proportion of patients with good outcome among patients with cerebral infarction vs patients without (23.5 and 61.1%; p = 0.005). Cerebral infarction was the only independent predictor of 6-month outcome (OR of good outcome 0.19, 95% CI 0.06 to 0.66).

Conclusions: The risk of developing posttraumatic cerebral infarction may be higher in patients with intracranial hypertension than in those without. Patients with posttraumatic cerebral infarction may be at increased risk of residual disability.

Disclosure: The authors report no conflicts of interest.

Received September 14, 2005. Accepted in final form June 1, 2006.

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				R. K. Menon, J. W. Norris, N. Latronico, R. Marino, L. Pinelli, and R. Gasparotti POSTTRAUMATIC CEREBRAL INFARCTION IN PATIENTS WITH MODERATE OR SEVERE HEAD TRAUMA Neurology, June 12, 2007; 68(24): 2160 - 2160. [Full Text] [PDF]

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