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
en En
| WPRIM
| ID: wpr-102399
Biblioteca responsable:
WPRO
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.
Palabras clave
Texto completo:
1
Índice:
WPRIM
Asunto principal:
Pronóstico
/
Lesiones Encefálicas
/
Flebografía
/
Activador de Plasminógeno de Tipo Uroquinasa
/
Presión Intracraneal
/
Terapia Trombolítica
/
Estudios Retrospectivos
/
Estudios de Seguimiento
/
Hipertensión Intracraneal
/
Diagnóstico Precoz
Tipo de estudio:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
Límite:
Humans
Idioma:
En
Revista:
Journal of Clinical Neurology
Año:
2013
Tipo del documento:
Article