Vasculature injury occurs rarely in traumatic brain injury but increases lifetime risk of ischemic or hemorrhage stroke. The diverse and nonspecific clinical manifestations make the diagnosis and treatment of these injuries highly challenging. With advancements in device design, endovascular treatments have become widely adopted, playing an increasingly vital role in the management of vascular diseases. The purpose of this review is to introduce and summarize endovascular treatments of traumatic cerebrovascular injury and other related pathological states after traumatic brain injury. Given the innovations of neuroendovascular devices and improvements in the techniques over the past decade, this review will outline several recent advancements in endovascular treatment strategies for cerebrovascular pathologies. Popularizing more treatment options to clinicians will benefit in dealing with a variety of clinical scenarios and reduce the overall morbidity of traumatic cerebrovascular injury.
Humans ; Endovascular Procedures/methods* ; Brain Injuries, Traumatic/complications* ; Cerebrovascular Trauma/therapy*

OBJECTIVE: To show the effect of dual monitoring including cardiac output (CO) and intracranial pressure (ICP) monitoring for severe traumatic brain injury (TBI) patiens. We hypothesized that meticulous treatment using dual monitoring is effective to sustain maintain minimal intensive care unit (ICU) complications and maintain optimal ICP and cerebral perfusion pressure (CPP) for severe TBI patiens. METHODS: We included severe TBI, below Glasgow Coma Scale (GCS) 8 and head abbreviation injury scale (AIS) >4 and performed decompressive craniectomy at trauma ICU of our hospital. We collected the demographic data, head AIS, injury severity score (ISS), initial GCS, ICU stay, sedation duration, fluid therapy related complications, Glasgow Outcome Scale (GOS) at 3 months and variable parameters of ICP and CO monitor. RESULTS: Thirty patients with severe TBI were initially selected. Thirteen patients were excluded because 10 patients had fixed pupillary reflexes and 3 patients had uncontrolled ICP due to severe brain edema. Overall 17 patients had head AIS 5 except 2 patients and 10 patients (58.8%) had multiple traumas as mean ISS 29.1. Overall complication rate of the patients was 64.7%. Among the parameters of CO monitoring, high stroke volume variation is associated with fluid therapy related complications (p=0.043) and low cardiac contractibility is associated with these complications (p=0.009) statistically. CONCLUSION: Combined use of CO and ICP monitors in severe TBI patients who could be necessary to decompressive craniectomy and postoperative sedation is good alternative methods to maintain an adequate ICP and CPP and reduce fluid therapy related complications during postoperative ICU care.
Brain Edema ; Brain Injuries* ; Cardiac Output* ; Cerebrovascular Circulation* ; Decompressive Craniectomy ; Fluid Therapy ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Head ; Humans ; Injury Severity Score ; Intensive Care Units ; Intracranial Pressure* ; Monitoring, Physiologic ; Multiple Trauma ; Reflex, Pupillary ; Stroke Volume

In Korea, injury is the third most common cause of death after cancer and cerebrovascular disease, but it is the major cause of death for the working age population under 40 years old. Also, the preventable trauma death rate in Korea is still higher than in developed countries. This fact has raised awareness of the need to establish a trauma system. For this reason, support services for the establishment of regional level 1 trauma centers was launched in 2012 by the Ministry of Health and Welfare. The purpose of this service is to designate 17 regional level 1 trauma centers distributed evenly across the country and to provide adequate care for seriously injured patients 24 hours a day, 7 days a week. As a result, the preventable trauma death rate is expected to fall to the level of the developed countries by 2020. As of November 2016, 16 regional level 1 trauma centers have been selected and 9 of them have officially opened. If the project is completed as planned, the quality of all phases of trauma care (prehospital, transport, and hospital) will be high, and the lives of seriously injured patients can more often be saved and their disabilities minimized.
Cause of Death ; Cerebrovascular Disorders ; Developed Countries ; Humans ; Korea ; Mortality ; Transportation ; Trauma Centers* ; Wounds and Injuries

We review current topics in sport-related head injuries including acute subdural hematoma (ASDH), traumatic cerebrovascular disease, cerebral concussion, and chronic traumatic encephalopathy (CTE). Sports-related ASDH is a leading cause of death and severe morbidity in popular contact sports like American football and Japanese judo. Rotational acceleration can cause either cerebral concussion or ASDH due to rupture of a parasagittal bridging vein. Although rare, approximately 80% of patients with cerebral infarction due to sport participation are diagnosed with ischemia or infarction due to arterial dissection. Computed tomography angiography, magnetic resonance angiography, and ultrasound are useful for diagnosing arterial dissection; ultrasound is particularly useful for detecting dissection of the common and internal carotid arteries. Repeated sports head injuries increase the risks of future concussion, cerebral swelling, ASDH, and CTE. To avoid fatal consequences of CTE, it is essential to understand the criteria for safe post-concussion sports participation. Once diagnosed with a concussion, an athlete should not be allowed to return to play on the same day and should not resume sports before the concussion symptoms have completely resolved. Information about the risks and management of head injuries in different sports should be widely disseminated in educational institutions and by sport organization public relations campaigns.
Acceleration ; Angiography ; Asian Continental Ancestry Group ; Athletes ; Brain Concussion ; Brain Injuries ; Brain Injury, Chronic ; Carotid Artery, Internal ; Cause of Death ; Cerebral Infarction ; Cerebrovascular Disorders ; Craniocerebral Trauma* ; Football ; Head* ; Hematoma, Subdural, Acute ; Humans ; Infarction ; Ischemia ; Magnetic Resonance Angiography ; Martial Arts ; Public Relations ; Rupture ; Sports ; Ultrasonography ; Veins

PURPOSE: Altered mental status (AMS) is a collective phrase that describes an undifferentiated assortment of disorders of mentation including impaired cognition, attention, awareness, and level of consciousness. Although AMS is a common chief complaint and a frequent issue in the emergency department (ED), the clinical surveys of AMS have not been conducted in Korea. We analyzed the AMS patients on the clinical basis. METHODS: From march 2002 to may 2002, we had enrolled prospectively 256 adult patients who visited the ED of Sanggye Paik Hospital because of AMS. The patients accompanied by AMS clinically were included, excluding patients caused by trauma, cerebrovascular accident with alert mentality. The clinical records were reviewed to analyze the clinical features of AMS, 9 months after discharge from ED. RESULTS: AMS was found in 256 patients which comprised the 2.2% of the ED patients during the test period, and 112 patients were admitted. The most commonly encountered mental status was drowsiness(36.3%), and the overall mortality rate 10.2%. The AMS was caused by neurogenic, metabolic, alcohol-related, psychogenic disorders in frequency accounting for most of AMS etiologies. CONCLUSION: This survey shows that the incidence of AMS is 2.2%, old age increases the rate of admission, and the common etiologies are neurogenic, metabolic, alcohol-related disorders. It seems prudent to approach the patients with AMS on the basis of etiologies and age.
Adult ; Alcohol-Related Disorders ; Cerebrovascular Trauma ; Cognition ; Consciousness ; Delirium ; Emergency Service, Hospital ; Humans ; Incidence ; Korea ; Mortality ; Prospective Studies ; Seizures

36 patients with age of 15-63 found the cerobrovascular pathology during 2/1997-2/1998 in friendship hospital by the cerebrovascular angiography. Methods: analysis of cerebral parenchyma to find the empty focus of sign and abnormal focus, taking the vascular photograph and analysis of the cerebrovasular by resetting as MIP program comparing with the images of CT scanner, image of DSA technique (4 patients) and results of operation (6 patients). The results have shown that the comparison of the operation (6 patients) with the angiography as technique DSA found that the MRI were suitable with the arteries with diameter of 5 mm and the abnormality of the vascular. The MRI of the cerebral parenchyma give the images which was more obviously than these of CT. scanner
Magnetic Resonance Spectroscopy ; Cerebrovascular Trauma

A consecutive series of 34 severe head-injured patients (DAI) were studied prospectively. Patients were categorized according to a new, simple classification system comprised of four lesion types according to the compression or obliteration of the ventricles or cisterns. Five patients belonged to type II and 19 patients to type IV. Each type was further subdivided into two GCS score ranges (5 to 8 and below 5). The distribution of the posttraumatic infarction was mainly in the frontal and temporal lobes (60% of all cases). Our data demonstrated that the ICP was significantly lower at a 30 degrees head elevation than at 0 degree (18.6 +/- 7.21 mmHg vs 23.0 +/- 10.60 mmHg. t = 4.22 p< 0.001), but head position did not statistically affect CPP (69.4 +/- 19.86 mmHg vs 68.2 +/- 19.87 mmHg. t = -0.54, p< 0.59). The effect of intensive therapy on ICP, CPP and AVDO2 was studied in all cases, employing steroids and diuretics in a modified intensive care scale. In cases where barbiturates were employed, there were statistically significant changes in ICP and AVDO2 (p< 0.001), but CPP was not affected (p< 0.59). Surviving patients were analyzed by using the GOS and the neurological grading score (NGS, Nihon University) of the persistent vegetative state. Our data suggests that head elevation of 30 degrees and barbiturate therapy are more effective on ICP and AVDO2, and NGS more exact than GOS in vegetative patients.
Adolescent ; Adult ; Aged ; Cerebrovascular Circulation ; Craniocerebral Trauma/*physiopathology/radiography ; *Glasgow Coma Scale ; Human ; Intracranial Pressure ; Middle Age ; Oxygen/blood ; Posture ; Prospective Studies ; Tomography, X-Ray Computed