Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1992 Jul;55(7):594–603. doi: 10.1136/jnnp.55.7.594

Cerebral blood flow, arteriovenous oxygen difference, and outcome in head injured patients.

C S Robertson 1, C F Contant 1, Z L Gokaslan 1, R K Narayan 1, R G Grossman 1
PMCID: PMC489173  PMID: 1640238

Abstract

Cerebral blood flow (CBF) and other physiological variables were measured repeatedly for up to 10 days after severe head injury in 102 patients, and CBF levels were related to outcome. Twenty five of the patients had a reduced CBF [mean (SD) 0.29 (0.05) ml/g/min]; 47 had a normal CBF, (0.41 (0.10) ml/g/min); and 30 had a raised CBF (0.62 (0.14) ml/g/min). Cerebral arteriovenous oxygen differences were inversely related to CBF and averaged 2.1 (0.7) mumol/ml in the group with reduced CBF, 1.9 (0.5) mumol/ml in the group with normal CBF, and 1.6 (0.4) mumol/ml in the group with raised CBF. Patients with a reduced CBF had a poorer outcome than patients with a normal or raised CBF. Mortality was highest in patients with a reduced CBF, and was 32% at three months after injury, whereas only 21% of the patients with a normal CBF and 20% of the patients with a raised CBF died. There were no differences in the type of injury, initial score on the Glasgow Coma Scale, mean intracranial pressure (ICP), highest ICP, or the amount of medical treatment required to keep the ICP less than 20 mm Hg in each group. Systemic factors did not significantly contribute to the differences in CBF among the three groups. A logistic regression model of the effect of CBF on neurological outcome was developed. When adjusted for variables which were found to be significant confounders, including age, initial Glasgow Coma Score, haemoglobin concentration, cerebral perfusion pressure and cerebral metabolic rate of oxygen, a reduced CBF remained significantly associated with an unfavourable neurological outcome.

Full text

PDF
597

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alberico A. M., Ward J. D., Choi S. C., Marmarou A., Young H. F. Outcome after severe head injury. Relationship to mass lesions, diffuse injury, and ICP course in pediatric and adult patients. J Neurosurg. 1987 Nov;67(5):648–656. doi: 10.3171/jns.1987.67.5.0648. [DOI] [PubMed] [Google Scholar]
  2. Bruce D. A., Alavi A., Bilaniuk L., Dolinskas C., Obrist W., Uzzell B. Diffuse cerebral swelling following head injuries in children: the syndrome of "malignant brain edema". J Neurosurg. 1981 Feb;54(2):170–178. doi: 10.3171/jns.1981.54.2.0170. [DOI] [PubMed] [Google Scholar]
  3. Bruce D. A., Langfitt T. W., Miller J. D., Schutz H., Vapalahti M. P., Stanek A., Goldberg H. I. Regional cerebral blood flow, intracranial pressure, and brain metabolism in comatose patients. J Neurosurg. 1973 Feb;38(2):131–144. doi: 10.3171/jns.1973.38.2.0131. [DOI] [PubMed] [Google Scholar]
  4. Bruce D. A., Raphaely R. C., Goldberg A. I., Zimmerman R. A., Bilaniuk L. T., Schut L., Kuhl D. E. Pathophysiology, treatment and outcome following severe head injury in children. Childs Brain. 1979;5(3):174–191. doi: 10.1159/000119817. [DOI] [PubMed] [Google Scholar]
  5. Enevoldsen E. M., Cold G., Jensen F. T., Malmros R. Dynamic changes in regional CBF, intraventricular pressure, CSF pH and lactate levels during the acute phase of head injury. J Neurosurg. 1976 Feb;44(2):191–214. doi: 10.3171/jns.1976.44.2.0191. [DOI] [PubMed] [Google Scholar]
  6. Fieschi C., Battistini N., Beduschi A., Boselli L., Rossanda M. Regional cerebral blood flow and intraventricular pressure in acute head injuries. J Neurol Neurosurg Psychiatry. 1974 Dec;37(12):1378–1388. doi: 10.1136/jnnp.37.12.1378. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Fleischer A. S., Payne N. S., Tindall G. T. Continuous monitoring of intracranial pressure in severe closed head injury without mass lesions. Surg Neurol. 1976 Jul;6(1):31–34. [PubMed] [Google Scholar]
  8. Gobiet W., Grote W., Bock W. J. The relation between intracrainal pressure, mean arterial pressure and cerebral blood flow in patients with severe head injury. Acta Neurochir (Wien) 1975;32(1-2):13–24. doi: 10.1007/BF01405899. [DOI] [PubMed] [Google Scholar]
  9. Jaggi J. L., Obrist W. D., Gennarelli T. A., Langfitt T. W. Relationship of early cerebral blood flow and metabolism to outcome in acute head injury. J Neurosurg. 1990 Feb;72(2):176–182. doi: 10.3171/jns.1990.72.2.0176. [DOI] [PubMed] [Google Scholar]
  10. Jennett B., Teasdale G., Braakman R., Minderhoud J., Heiden J., Kurze T. Prognosis of patients with severe head injury. Neurosurgery. 1979 Apr;4(4):283–289. doi: 10.1227/00006123-197904000-00001. [DOI] [PubMed] [Google Scholar]
  11. Kety S. S., Schmidt C. F. THE NITROUS OXIDE METHOD FOR THE QUANTITATIVE DETERMINATION OF CEREBRAL BLOOD FLOW IN MAN: THEORY, PROCEDURE AND NORMAL VALUES. J Clin Invest. 1948 Jul;27(4):476–483. doi: 10.1172/JCI101994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Langfitt T. W., Obrist W. D., Gennarelli T. A., O'Connor M. J., Weeme C. A. Correlation of cerebral blood flow with outcome in head injured patients. Ann Surg. 1977 Oct;186(4):411–414. doi: 10.1097/00000658-197710000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Luerssen T. G., Klauber M. R., Marshall L. F. Outcome from head injury related to patient's age. A longitudinal prospective study of adult and pediatric head injury. J Neurosurg. 1988 Mar;68(3):409–416. doi: 10.3171/jns.1988.68.3.0409. [DOI] [PubMed] [Google Scholar]
  14. Muizelaar J. P., Marmarou A., DeSalles A. A., Ward J. D., Zimmerman R. S., Li Z., Choi S. C., Young H. F. Cerebral blood flow and metabolism in severely head-injured children. Part 1: Relationship with GCS score, outcome, ICP, and PVI. J Neurosurg. 1989 Jul;71(1):63–71. doi: 10.3171/jns.1989.71.1.0063. [DOI] [PubMed] [Google Scholar]
  15. Narayan R. K., Greenberg R. P., Miller J. D., Enas G. G., Choi S. C., Kishore P. R., Selhorst J. B., Lutz H. A., 3rd, Becker D. P. Improved confidence of outcome prediction in severe head injury. A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning, and intracranial pressure. J Neurosurg. 1981 Jun;54(6):751–762. doi: 10.3171/jns.1981.54.6.0751. [DOI] [PubMed] [Google Scholar]
  16. Obrist W. D., Gennarelli T. A., Segawa H., Dolinskas C. A., Langfitt T. W. Relation of cerebral blood flow to neurological status and outcome in head-injured patients. J Neurosurg. 1979 Sep;51(3):292–300. doi: 10.3171/jns.1979.51.3.0292. [DOI] [PubMed] [Google Scholar]
  17. Obrist W. D., Langfitt T. W., Jaggi J. L., Cruz J., Gennarelli T. A. Cerebral blood flow and metabolism in comatose patients with acute head injury. Relationship to intracranial hypertension. J Neurosurg. 1984 Aug;61(2):241–253. doi: 10.3171/jns.1984.61.2.0241. [DOI] [PubMed] [Google Scholar]
  18. Overgaard J., Tweed W. A. Cerebral circulation after head injury. 1. Cerebral blood flow and its regulation after closed head injury with emphasis on clinical correlations. J Neurosurg. 1974 Nov;41(5):531–541. doi: 10.3171/jns.1974.41.5.0531. [DOI] [PubMed] [Google Scholar]
  19. Overgaard J., Tweed W. A. Cerebral circulation after head injury. Part 4: Functional anatomy and boundary-zone flow deprivation in the first week of traumatic coma. J Neurosurg. 1983 Sep;59(3):439–446. doi: 10.3171/jns.1983.59.3.0439. [DOI] [PubMed] [Google Scholar]
  20. Robertson C. S., Grossman R. G., Goodman J. C., Narayan R. K. The predictive value of cerebral anaerobic metabolism with cerebral infarction after head injury. J Neurosurg. 1987 Sep;67(3):361–368. doi: 10.3171/jns.1987.67.3.0361. [DOI] [PubMed] [Google Scholar]
  21. Robertson C. S., Narayan R. K., Gokaslan Z. L., Pahwa R., Grossman R. G., Caram P., Jr, Allen E. Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients. J Neurosurg. 1989 Feb;70(2):222–230. doi: 10.3171/jns.1989.70.2.0222. [DOI] [PubMed] [Google Scholar]
  22. Tabaddor K., Bhushan C., Pevsner P. H., Walker A. E. Prognostic value of cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO 2 ) in acute head trauma. J Trauma. 1972 Dec;12(12):1053–1055. doi: 10.1097/00005373-197212000-00006. [DOI] [PubMed] [Google Scholar]
  23. Teasdale G., Skene A., Parker L., Jennett B. Age and outcome of severe head injury. Acta Neurochir Suppl (Wien) 1979;28(1):140–143. doi: 10.1007/978-3-7091-4088-8_33. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES