The Clinical Timeline and Predictors of Post Traumatic Vasospasm: Association with Traumatic Subarachnoid Hemorrhage in the Fissures and Cisterns

Saturday, May 4, 2024

1:51 PM – 1:53 PM CT

Location: S405a

Presenting Author(s)

Sonora Windermere, MD, JD (she/her/hers)

Surgical Resident
Boston Medical Center, Boston University School of Medicine, and University of Florida Department of Surgery
Gainesville, FL, US

Co-Author(s)

EB

Emanuela Binello, M.D. PHD

ScDDepartment of Neurosurgery, Boston University
Boston Medical Center
Boston, Massachusetts, United States
AC

Anna Cervantes-Arslanian, MD

Attending Physician
Boston Medical Center and Boston University School of Medicine, United States
AD

Ali Daneshmand, MD, MPH

Attending Physician
Boston Medical Center and Boston University School of Medicine, United States
SM

Sarah Morris, BS

Medical Student
Boston Medical Center and Boston University School of Medicine, United States
DT

Dominic Tran, MD

Resident Physician
Boston Medical Center and Boston University School of Medicine, United States
SY

Sara Young, MD

Resident Physician
Boston Medical Center and Boston University School of Medicine, United States

Disclosure(s):

Sonora Andromeda Windermere, MD, JD: No financial relationships to disclose

Introduction: Unlike aneurysmal rupture, post traumatic vasospasm is poorly understood without guidelines-based recommendations for surveillance. This study evaluated timing and severity of doppler-diagnosed vasospasm in traumatic brain injury (TBI) in a single-center retrospective study.

Methods: Over 6 years, TBI patients admitted to the ICU with 2+ instances of TCD-diagnosed vasospasm were included. Clinical timelines, TBI severity by Glasgow Coma Score (GCS) (mild = 13-15, moderate = 9-12, severe = 3-8), presence of subarachnoid hemorrhage (tSAH), and vasospasm severity (mild, moderate, or severe) were extracted from records. One-way ANOVA analysis compared the highest vasospasm severity noted with onset date and total vasospasm days. Significant differences in means were analyzed with Games-Howell post-hoc test. Stata® assessed dependence of severity upon imaging findings or GCS via Chi2 analysis.

Results: Forty-four patients were identified (31 male, 13 female, median age 40 (15-92) years). Amongst mild TBIs (13), vasospasm was mild (9), moderate (1), or severe (3). For moderate TBIs (2), vasospasm was mild (1), moderate (0), or severe (1). For severe TBIs (29), vasospasm was mild (16), moderate (6), or severe (7). Thirty-two patients had tSAH, 19 with mild, 6 moderate, and 7 with severe vasospasm. Of the 12 patients without tSAH, 7 had mild, 1 moderate, and 4 with severe vasospasm. Of the 32 patients with tSAH, 30 either sylvian fissure and/or cisternal tSAH, the remaining 2 having only cortical tSAH. Median time to onset did not differ between mild (Hospital Day (HD) 3), moderate (HD 4), and severe (HD 3) vasospasm (p=0.47). Mean duration of mild vasospasm (2.35 days) differed from severe (6.73 days), (p < 0.05). Neither tSAH presence nor TBI severity was related to vasospasm severity (p= 0.11 and p=0.61)

Conclusion : As post-traumatic vasospasm impacts TBI patients regardless of GCS, we recommend early, routine PTV surveillance for critically ill TBI patients especially with fissure/cisternal hemorrhage.