caa a22 4500 606215255 CHVBK 20210128101058.0 cr unu---uuuuu 210128e20151001xx s 000 0 eng 10.1007/s00701-015-2559-5 doi (NATIONALLICENCE)springer-10.1007/s00701-015-2559-5 Posttraumatic cerebral infarction in severe traumatic brain injury: characteristics, risk factors and potential mechanisms [Elektronische Daten] [Shengwen Liu, Xueyan Wan, Sheng Wang, Lulu Huang, Mingxin Zhu, Suojun Zhang, Xing Liu, Qungen Xiao, Chao Gan, Chaoxi Li, Kai Shu, Ting Lei] Background: Posttraumatic cerebral infarction (PTCI) is a severe secondary insult of traumatic brain injury (TBI). This study aimed to evaluate the characteristics and risk factors of PTCI after severe TBI (sTBI) and explore possible mechanism. Methods: This retrospective study included a cohort of 339 patients with sTBI; they were divided into the PTCI and non-PTCI groups. Clinical data and follow-up charts were reviewed for comparison. The logistic regression model was used for multivariate analysis to detect the risk factors of PTCI. The Glasgow Outcome Scale (GOS) and Barthel index (BI) for activities of daily living (ADL) were applied to evaluate their outcome. Results: PTCI led to an increased mortality (43.5% vs. 10.7%, P < 0.001) and days of intensive care unit stay (14.3days vs. 7.1days, P < 0.001), decreased GOS (3.1 vs. 4.1, P < 0.001) and BI (25.0 vs. 77.9, P < 0.001). Increased infarction volume led to poor outcome assessed by GOS (r = −0.46, P < 0.0001) and BI for ADL (r = −0.36, P = 0.026) for surviving patients. Compared with non-PTCI patients, PTCI patients had a high incidence of midline shift (36.2% vs. 20.7%, P = 0.011) and posttraumatic vasospasm (PTV) (42.0% vs. 27.4%, P = 0.027). Daily prevalence of PTCI occurred in two peaks: one (73.9%) was in the first 24h after injury, while the other (18.8%) was in the span of 43 to 60h postinjury. In multivariate analysis, hyperthermia [adjusted odds ratio (OR), 3.11; P = 0.001] in the first 24h, thrombocytopenia (OR, 27.08; P < 0.001), abnormal prothrombin time (OR, 7.66; P < 0.001) and traumatic subarachnoid hemorrhage (OR, 2.33; P = 0.022) were independent predictors for PTCI. Conclusions: PTCI deteriorates the outcome of sTBI patients. Mechanical compression and hemocoagulative disturbance serve as potential mechanisms mediating this pathophysiological process. PTV may also contribute to PTCI, but its association with PTCI is weak and needs further exploration. Early recognition and intervention of these factors might be beneficial for preventing PTCI. Springer-Verlag Wien, 2015 Posttraumatic cerebral infarction nationallicence Severe traumatic brain injury nationallicence Risk factors nationallicence Mechanism nationallicence Liu Shengwen Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut Wan Xueyan Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut Wang Sheng Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut Huang Lulu Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut Zhu Mingxin Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut Zhang Suojun Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut Liu Xing Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut Xiao Qungen Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut Gan Chao Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut Li Chaoxi Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut Shu Kai Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut Lei Ting Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut Acta Neurochirurgica Springer Vienna 157/10(2015-10-01), 1697-1704 0001-6268 157:10<1697 2015 157 701 https://doi.org/10.1007/s00701-015-2559-5 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2559-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Liu Shengwen Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut NATIONALLICENCE 700 1- Wan Xueyan Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut NATIONALLICENCE 700 1- Wang Sheng Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut NATIONALLICENCE 700 1- Huang Lulu Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut NATIONALLICENCE 700 1- Zhu Mingxin Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut NATIONALLICENCE 700 1- Zhang Suojun Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut NATIONALLICENCE 700 1- Liu Xing Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut NATIONALLICENCE 700 1- Xiao Qungen Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut NATIONALLICENCE 700 1- Gan Chao Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut NATIONALLICENCE 700 1- Li Chaoxi Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut NATIONALLICENCE 700 1- Shu Kai Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut NATIONALLICENCE 700 1- Lei Ting Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, 430030, Wuhan, Hubei Province, People's Republic of China aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/10(2015-10-01), 1697-1704 0001-6268 157:10<1697 2015 157 701