Post-Traumatic Cerebral Infarction: A Narrative Review of Pathophysiology, Diagnosis, and Treatment
Javier Amador-Casta?eda, BHS, RRT, FCCM
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Poblete RA, Zhong C, Patel A, Kuo G, Sun PY, Xiao J, Fan Z, Sanossian N, Towfighi A, Lyden PD. Post-Traumatic Cerebral Infarction: A Narrative Review of Pathophysiology, Diagnosis, and Treatment. Neurology International. 2024; 16(1):95-112. https://doi.org/10.3390/neurolint16010006
Summary of "Post-Traumatic Cerebral Infarction: A Narrative Review of Pathophysiology, Diagnosis, and Treatment"
Summary:
This narrative review delves into post-traumatic cerebral infarction (PTCI), an under-recognized complication following traumatic brain injury (TBI) associated with poor functional outcomes. The article explores the pathophysiology of PTCI, identifying primary causes such as brain herniation, cervical artery dissection, cerebral venous thrombosis, and post-traumatic vasospasm. Additionally, the review examines diagnostic and treatment approaches, underscoring the necessity of early recognition and intervention to limit secondary brain injury.
Key Points:
1. Impact of TBI: TBI is a significant cause of morbidity, with PTCI contributing to worsened outcomes and secondary brain injury.
2. Pathophysiology of PTCI: Common causes include brain herniation syndromes, cervical artery dissection, venous thrombosis, and vasospasm.
3. Hypercoagulability Post-TBI: TBI often leads to a hypercoagulable state, increasing the risk of cerebral infarction.
4. Brain Herniation Mechanisms: Elevated intracranial pressure (ICP) can result in cerebral infarction due to vessel compression and ischemia.
5. Cervical Artery Dissection (CAD): Occurs in moderate-to-severe TBI due to vessel wall tears, contributing to stroke via thromboembolism.
6. Post-Traumatic Vasospasm: Less studied but linked to poorer outcomes, vasospasm may cause cerebral ischemia through vessel constriction.
7. Cerebral Venous Thrombosis: Can lead to infarction due to impaired venous drainage, especially following skull fractures.
8. Diagnostic Imaging: CT and MRI are primary modalities, while angiography and vessel wall imaging provide detailed assessments.
9. Treatment Protocols: Include ICP management, antithrombotic therapy for CAD, vasodilators for vasospasm, and supportive measures.
10. Research Needs: Calls for further research into PTCI mechanisms and optimal management strategies to improve TBI outcomes.
Conclusion:
The article emphasizes the importance of recognizing PTCI in TBI patients due to its association with poor outcomes. Effective management of ICP, timely use of imaging, and tailored therapies for complications like vasospasm and CAD may improve recovery. Future studies should focus on refining diagnostic and treatment protocols for PTCI to enhance patient outcomes in TBI care.
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Discussion Questions:
1. How can diagnostic criteria be improved to allow for earlier detection and intervention of PTCI in TBI patients?
2. What role might advanced imaging techniques, like vessel wall imaging, play in the management of PTCI?
3. What are the challenges in implementing individualized treatment protocols for the various pathophysiologic causes of PTCI?
? 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).