Cerebral Net Water Uptake in Posttraumatic Cerebral Ischemia

We assessed net water uptake changes (NWU) in regions of posttraumatic ischemia in relation to cerebral microcirculation mean transit time (MTT) at moderate-to-severe traumatic brain injury (TBI).

Materials and methods: 128 moderate-to-severe traumatic brain injury patients (44 women, 84 men, age: 37 ± 12 years) were stratified into 3 groups: Marshall 2-3: 48 patients, Marshall 4: 44 patients, Marshall 5: 36 patients. The groups were matched by sex and age. Patients received multiphase perfusion computed tomography (PCT) 1-5 days after admission. Net water uptake was calculated from non-contrast computed tomography. Data are shown as a median [interquartile range]. P < 0.05 was considered statistically significant.

Results: Cerebral blood flow in posttraumatic ischemia foci in Marshall 4 group was significantly higher than that in the Marshall 5 group (p = 0.027). Net water uptake in posttraumatic ischemia zones was significantly higher than in zones without posttraumatic ischemia (8.1% versus 4.2%, p < 0.001). Mean transit time in posttraumatic ischemia zones was inversely and significantly correlated with higher net water uptake (R² = 0,089, p < 0.01).

Conclusions: Delay of blood flow through the cerebral microvascular bed was significantly correlated with the increased net water uptake in posttraumatic ischemia foci. Marshall's classification did not predict the progression of posttraumatic ischemia.