Cerebral circulation in traumatic brain injury patients with acute subdural hematoma: A xenon CT and perfusion CT study

抄録

  Acute subdural hematoma (ASDH) represents a major clinical entity in severe traumatic brain injury (sTBI). sTBI is reported to cause cerebral circulatory disturbances at the acute stage. Here we focused on the cerebral circulation of ASDH patients, evaluated the absolute left‒right difference between cerebral hemispheres, and compared the cerebral circulation between groups with and without favorable outcomes. We retrospectively reviewed the cases of 31 patients with ASDH. Xenon‒computed tomography (Xe‒CT) and perfusion CT had been performed simultaneously in each patient to evaluate the cerebral circulation on post‒injury days 1‒3. The cerebral blood flow (CBF) was measured by Xe‒CT and the mean transit time (MTT) was measured by perfusion CT, and the cerebral blood volume (CBV) was calculated. A significant absolute difference in cerebral circulation between the hemispheres among different types of TBI was observed in the patients’ MTT values. There was no significant difference in these parameters between left‒right hemispheres with ASDH among the favorable outcome group and unfavorable group. There were no significant differences in age, Glasgow Coma Scale score at the onset of treatment, CBF, or CBV. Only the MTT was significantly different between the favorable outcome and unfavorable outcome groups. The circulatory disturbance in ASDH patients occurs diffusely despite the focal injury. Additionally, in patients with unfavorable outcomes, the circulatory disturbance is worse than that in favorable patients. We must adopt a treatment strategy appropriate to the pathophysiology of the different TBI types.