Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep;165(9):2381-2387.
doi: 10.1007/s00701-023-05703-6. Epub 2023 Jul 18.

Cerebral perfusion changes in acute subdural hematoma

J Winkler  1 , G S Piedade  2   3 , C Rubbert  4 , B B Hofmann  1 , M A Kamp  5 , P J Slotty  1
Affiliations

Cerebral perfusion changes in acute subdural hematoma

J Winkler et al. Acta Neurochir (Wien). 2023 Sep.

Abstract

Introduction: Acute subdural hematoma (aSDH) is one of the main causes of high mortality and morbidity in traumatic brain injury. Prognosis is poor due to the rapid volume shift and mass effect. Cerebral perfusion is likely affected in this condition. This study quantifies perfusion changes in aSDH using early ER polytrauma CT with perfusion imaging (CTP).

Methods: Data of 54 patients with traumatic aSDH were retrospectively collected. Glasgow Coma scale (GCS), perfusion parameters, therapeutic decisions and imaging data including hematoma thickness, midline shift, and hematoma localization were analyzed. The cortical perfusion parameters of each hemisphere, the area anterior to the hematoma (AAH), area below the hematoma (ABH), area posterior to the hematoma (PAH), and corresponding mirrored contralateral regions were determined.

Results: We found a significant difference in Tmax in affected and unaffected whole-hemisphere data (mean 4.0 s vs. 3.3 s, p < 0.05) and a significantly different mean for Tmax in ABH and for the corresponding mirrored area (mABH) (mean 3.8 s vs. 3.1 s, p < 0.05). No significant perfusion changes in cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) were found.

Conclusion: There was a significant elevation of time to maximum (Tmax) values in the underlying cortical area of aSDH. Possible pathophysiological explanations, the influence on immediate surgical decision-making and further therapeutic consequences have to be evaluated.

Keywords: Acute subdural hematoma; CT perfusion; Cerebral perfusion; Traumatic brain injury.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Native CT scan and identification of the analyzed areas
Fig. 2
Fig. 2
CTP of a patient with left hemispherical aSDH
Fig. 3
Fig. 3
Boxplots of the median CBF, CBV, Tmax, and MTT perfusion values measured in the whole brain and differentiated by age. In the middle aged group (40–65 years) exists an additional outlier value at CBF = 352.7 and CBV = 114.8. Both values are not included in the plots due to illustration purposes
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Bastos-Leite AJ, Kuijer JP, Rombouts SA, Sanz-Arigita E, van Straaten EC, Gouw AA, van der Flier WM, Scheltens P, Barkhof F. Cerebral blood flow by using pulsed arterial spin-labeling in elderly subjects with white matter hyperintensities. AJNR Am J Neuroradiol. 2008;29:1296–1301. doi: 10.3174/ajnr.A1091. - DOI - PMC - PubMed
    1. Bendinelli C, Bivard A, Nebauer S, Parsons MW, Balogh ZJ. Brain CT perfusion provides additional useful information in severe traumatic brain injury. Injury. 2013;44:1208–1212. doi: 10.1016/j.injury.2013.03.039. - DOI - PubMed
    1. Biagi L, Abbruzzese A, Bianchi MC, Alsop DC, Del Guerra A, Tosetti M. Age dependence of cerebral perfusion assessed by magnetic resonance continuous arterial spin labeling. J Magn Reson Imaging. 2007;25:696–702. doi: 10.1002/jmri.20839. - DOI - PubMed
    1. Biggs D, Silverman ME, Chen F, Walsh B, Wynne P. How should we treat patients who wake up with a stroke? A review of recent advances in management of acute ischemic stroke. Am J Emerg Med. 2019;37:954–959. doi: 10.1016/j.ajem.2019.02.010. - DOI - PubMed
    1. Calamante F, Christensen S, Desmond PM, Ostergaard L, Davis SM, Connelly A. The physiological significance of the time-to-maximum (Tmax) parameter in perfusion MRI. Stroke. 2010;41:1169–1174. doi: 10.1161/STROKEAHA.110.580670. - DOI - PubMed

Publication types

LinkOut - more resources