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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2016

Open Access 01-12-2016 | Original research

Head computed tomographic measurement as a predictor of outcome in patients with subdural hematoma with cerebral edema

Authors: Hitoshi Yamamura, Takasei Morioka, Tomonori Yamamoto, Yasumitsu Mizobata

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2016

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Abstract

Background

The ability to predict outcome in patients with cerebral edema is important because it can influence treatment strategy. We evaluated whether differences in head computed tomographic (CT) measurements in Hounsfield units (HU) of white matter and gray matter can be used as a predictor of outcome in patients with subdural hematoma with cerebral edema.

Methods

We evaluated 34 patients who had subdural hematoma with cerebral edema following acute closed head trauma and had undergone head CT within a few hours of admission. We divided them into the survival (n = 24) group and death (n = 10) group, and measured the HU of white matter and gray matter at injury and non-injury sites.

Results

There were no significant differences in operation time or blood loss during surgery between the two groups. Only the HU of white matter in the injury site of patients in the death group were decreased significantly. A cut-off value of 31.5 for HU of white matter showed 80.0 % sensitivity and 99.9 % specificity for death; the area under the curve was 0.91.

Discussion

Our results are more evidence of the support of neurogenic edema in trauma rather than an important clinical tool at this stage. However, HU values in WM may be one factor in the decision-making process that affects patient outcome. Changing the treatment strategy in patients with a low HU value in the WM at the injury site may bring about an improvement in patient outcome.

Conclusion

Measurement in HU of white matter at the injury site might be useful as a predictor of outcome in patients with subdural hematoma with cerebral edema.
Literature
1.
Kim H, Kim GD, Yoon BC, Kim K, Kim BJ, Choi Y, Czosnyka M, Oh BM, Kim DJ. Quantitative analysis of computed tomography images and early detection of cerebral edema for pediatric traumatic brain injury patients: retrospective study. BMC Med. 2014;12:186.CrossRefPubMedPubMedCentral
2.
Michiue T, Sakurai T, Ishikawa T, Oritani S, Maeda H. Quantitative analysis of pulmonary pathophysiology using postmortem computed tomography with regard to the cause of death. Forensic Sci Int. 2012;220:232–8.CrossRefPubMed
3.
Yuh EL, Cooper SR, Ferguson AR, Manley GT. Quantitative CT improves outcome prediction in acute traumatic brain injury. J Neurotrauma. 2012;29:735–46.CrossRefPubMedPubMedCentral
4.
Chieregato A, Fainardi E, Morselli-Labate AM, Antonelli V, Compagnone C, Targa L, Kraus J, Servadei F. Factors associated with neurological outcome and lesion progression in traumatic subarachnoid hemorrhage patients. Neurosurgery. 2005;56:671–80. discussion −80.CrossRefPubMed
5.
Huang AP, Lee CW, Hsieh HJ, Yang CC, Tsai YH, Tsuang FY, Kuo LT, Chen YS, Tu YK, Huang SJ, et al. Early parenchymal contrast extravasation predicts subsequent hemorrhage progression, clinical deterioration, and need for surgery in patients with traumatic cerebral contusion. J Trauma. 2011;71:1593–9.CrossRefPubMed
6.
Metter RB, Rittenberger JC, Guyette FX, Callaway CW. Association between a quantitative CT scan measure of brain edema and outcome after cardiac arrest. Resuscitation. 2011;82:1180–5.CrossRefPubMedPubMedCentral
7.
Bouma GJ, Muizelaar JP, Fatouros P. Pathogenesis of traumatic brain swelling: role of cerebral blood volume. Acta Neurochir Suppl. 1998;71:272–5.PubMed
8.
Hom J, Dankbaar JW, Soares BP, Schneider T, Cheng SC, Bredno J, Lau BC, Smith W, Dillon WP, Wintermark M. Blood–brain barrier permeability assessed by perfusion CT predicts symptomatic hemorrhagic transformation and malignant edema in acute ischemic stroke. AJNR. 2011;32:41–8.CrossRefPubMed
9.
McCourt R, Gould B, Gioia L, Kate M, Coutts SB, Dowlatshahi D, Asdaghi N, Jeerakathil T, Hill MD, Demchuk AM, et al. Cerebral perfusion and blood pressure do not affect perihematoma edema growth in acute intracerebral hemorrhage. Stroke. 2014;45:1292–8.CrossRefPubMed
10.
Barzó P, Marmarou A, Fatouros P, Hayasaki K, Corwin F. Contribution of vasogenic and cellular edema to traumatic brain swelling measured by diffusion-weighted imaging. J Neurosurg. 1997;87:900–7.CrossRefPubMed
11.
Lin W, Venkatesan R, Gurleyik K, He YY, Powers WJ, Hsu CY. An absolute measurement of brain water content using magnetic resonance imaging in two focal cerebral ischemic rat models. J Cereb Blood Flow Metab. 2000;20:37–44.CrossRefPubMed
12.
Marmarou A, Signoretti S, Fatouros PP, Portella G, Aygok GA, Bullock MR. Predominance of cellular edema in traumatic brain swelling in patients with severe head injuries. J Neurosurg. 2006;104:720–30.CrossRefPubMed
13.
Bor-Seng-Shu E, Paiva WS, Figueiredo EG, Fujimoto Y, de Andrade AF, Fonoff ET, Teixeira MJ. Posttraumatic refractory intracranial hypertension and brain herniation syndrome: cerebral hemodynamic assessment before decompressive craniectomy. BioMed Res Int. 2013;2013:750809.CrossRefPubMedPubMedCentral
14.
von Holst H, Li X, Kleiven S. Increased strain levels and water content in brain tissue after decompressive craniotomy. Acta Neurochir. 2012;154:1583–93.CrossRef
15.
Altman D. Practical Statistics for Medical Research. London: Chapman and Hall; 1991.
16.
Dzialowski I, Klotz E, Goericke S, Doerfler A, Forsting M, von Kummer R. Ischemic brain tissue water content: CT monitoring during middle cerebral artery occlusion and reperfusion in rats. Radiology. 2007;243:720–6.CrossRefPubMed
17.
Morimoto Y, Kemmotsu O, Kitami K, Matsubara I, Tedo I. Acute brain swelling after out-of-hospital cardiac arrest: pathogenesis and outcome. Crit Care Med. 1993;21:104–10.CrossRefPubMed
18.
Torbey MT, Selim M, Knorr J, Bigelow C, Recht L. Quantitative analysis of the loss of distinction between gray and white matter in comatose patients after cardiac arrest. Stroke. 2000;31:2163–7.CrossRefPubMed
19.
Choi SP, Park HK, Park KN, Kim YM, Ahn KJ, Choi KH, Lee WJ, Jeong SK. The density ratio of grey to white matter on computed tomography as an early predictor of vegetative state or death after cardiac arrest. Emerg Med J. 2008;25:666–9.CrossRefPubMed
20.
Yamamura H, Kaga S, Kaneda K, Yamamoto T, Mizobata Y. Head computed tomographic measurement as an early predictor of outcome in hypoxic-ischemic brain damage patients treated with hypothermia therapy. Scand J Trauma Resusc Emerg Med. 2013;21:37.CrossRefPubMedPubMedCentral
21.
Bartels RH, Meijer FJ, van der Hoeven H, Edwards M, Prokop M. Midline shift in relation to thickness of traumatic acute subdural hematoma predicts mortality. BMC Neurol. 2015;15:220.CrossRefPubMedPubMedCentral
22.
Klatzo I. Presidental address. Neuropathological aspects of brain edema. J Neuropathol Exp Neurol. 1967;26:1–14.CrossRefPubMed
23.
Rodriguez-Baeza A, Reina-de La Torre F, Poca A, Marti M, Garnacho A. Morphological features in human cortical brain microvessels after head injury: a three-dimensional and immunocytochemical study. Anat Rec A Discov Mol Cell Evol Biol. 2003;273:583–93.CrossRefPubMed
24.
Bullock R, Smith R, Favier J, du Trevou M, Blake G. Brain specific gravity and CT scan density measurements after human head injury. J Neurosurg. 1985;63:64–8.CrossRefPubMed
Metadata
Title
Head computed tomographic measurement as a predictor of outcome in patients with subdural hematoma with cerebral edema
Authors
Hitoshi Yamamura
Takasei Morioka
Tomonori Yamamoto
Yasumitsu Mizobata
Publication date
01-12-2016
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-016-0271-y

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