Early Diagnosis and Management of Cerebral Venous Flow Obstruction Secondary to Transsinus Fracture after Traumatic Brain Injury
Journal of Clinical Neurology
;
: 259-268, 2013.
Article
in English
| WPRIM
| ID: wpr-102399
ABSTRACT
BACKGROUND AND PURPOSE:
Cerebral venous flow obstruction (CVFO) is a fatal complication of traumatic brain injury. To compare the outcomes of patients with CVFO secondary to traumatic-brain-injury-induced transsinus fracture who were diagnosed early versus those diagnosed late in the therapeutic course.METHODS:
In total, 403 patients with transsinus fracture were reviewed retrospectively. The patients were divided into an early-diagnosis group (n=338) and a delayed-diagnosis group (n=65). The patients submitted to 2D time-of-flight magnetic resonance venography (2D-TOF MRV) and/or CT venography (CTV), depending upon the findings of intracranial pressure monitoring, in order to identify potentially complicated CVFO. These examinations took place within 3 days of the onset of malignant intracranial hypertension symptoms in the early-diagnosis group, and after an average of 7 days in the delayed-diagnosis group. Once diagnosed, patients received intravenous thrombolytic therapy with low-dose urokinase. Patients with massive transsinus epidural hematoma, depressed fracture, or cerebral hernia were treated surgically to relieve the compression and repair any damage to the venous sinuses.RESULTS:
Cerebral venous flow obstruction was much more severe in the delayed-diagnosis group than in the early-diagnosis group (p<0.001), and hence patients in the former group were given a higher dose of urokinase (p<0.001) for thrombolytic therapy. They were also significantly more likely to need surgery (48.1% vs. 20.6%, p=0.003) and had a higher mortality rate (37.0% vs. 4.1%, p<0.001). However, patients in both groups experienced a similarly favorable prognosis, not only with regard to functional outcome but also with respect to neuroradiological improvement, as evaluated by 2D-TOF MRV/CTV at the final follow-up (p=0.218).CONCLUSIONS:
Delayed diagnosis can result in increased risk of surgery and death in the acute phase. Thrombolytic therapy with low-dose urokinase resulted in promising improvements in both functional and neuroradiological outcomes in all of the patients in this study, regardless of the time to diagnosis.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Prognosis
/
Brain Injuries
/
Phlebography
/
Urokinase-Type Plasminogen Activator
/
Intracranial Pressure
/
Thrombolytic Therapy
/
Retrospective Studies
/
Follow-Up Studies
/
Intracranial Hypertension
/
Early Diagnosis
Type of study:
Diagnostic study
/
Observational study
/
Prognostic study
/
Risk factors
/
Screening study
Limits:
Humans
Language:
English
Journal:
Journal of Clinical Neurology
Year:
2013
Type:
Article
Similar
MEDLINE
...
LILACS
LIS