Predominance of cellular edema in traumatic brain swelling in patients with severe head injuries

Anthony Marmarou, Stefano Signoretti, Panos P. Fatouros, Gina Portella, Gunes A. Aygok, Ross Bullock

Research output: Contribution to journalArticle

146 Citations (Scopus)

Abstract

Object. The edema associated with brain swelling after traumatic brain injury (TBI) has been thought to be vasogenic in origin, but the results of previous laboratory studies by the authors have shown that a cellular form of edema is mainly responsible for brain swelling after TBI. In this study the authors used magnetic resonance (MR) imaging techniques to identify the type of edema that occurs in patients with TBI. Methods. Diffusion-weighted MR imaging was used to evaluate the apparent diffusion coefficient (ADC) in 44 patients with TBI (Glasgow Coma Scale Score < 8) and in eight healthy volunteers. Higher ADC values have been associated with vasogenic edema, and lower ADC values with a predominantly cellular form of edema. Regional measurements of ADC in patients with focal and diffuse injury were computed. The water content of brain tissue was also assessed in absolute terms by using MR imaging to measure the percentage of water per gram of tissue. Cerebral blood flow (CBF) was measured using stable Xe-computerized tomography (CT) studies to rule out ischemia as a cause of cellular edema. The mean ADC value in the healthy volunteers was 0.82 ± 0.05 × 10-3 mm2/second. The ADC values in the patients with diffuse brain injury without swelling were close to the mean for the healthy volunteers. In contrast, the patients with brain swelling had increased brain water content and low ADC values (mean 0.74 ± 0.05 × 10-3 mm2/second). The ADC values correlated with CT classifications. In all patients with low ADC values, the CBF values were outside the range for ischemia. Conclusions. The brain swelling observed in patients with TBI appears to be predominantly cellular, as signaled by low ADC values in brain tissue with high levels of water content.

Original languageEnglish
Pages (from-to)720-730
Number of pages11
JournalJournal of Neurosurgery
Volume104
Issue number5
DOIs
StatePublished - May 1 2006
Externally publishedYes

Fingerprint

Brain Edema
Craniocerebral Trauma
Edema
Cerebrovascular Circulation
Healthy Volunteers
Water
Brain
Ischemia
Tomography
Magnetic Resonance Imaging
Glasgow Coma Scale
Diffusion Magnetic Resonance Imaging
Traumatic Brain Injury

Keywords

  • Apparent diffusion coefficient
  • Brain edema
  • Brain injury
  • Head injury
  • Trauma

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Marmarou, A., Signoretti, S., Fatouros, P. P., Portella, G., Aygok, G. A., & Bullock, R. (2006). Predominance of cellular edema in traumatic brain swelling in patients with severe head injuries. Journal of Neurosurgery, 104(5), 720-730. https://doi.org/10.3171/jns.2006.104.5.720

Predominance of cellular edema in traumatic brain swelling in patients with severe head injuries. / Marmarou, Anthony; Signoretti, Stefano; Fatouros, Panos P.; Portella, Gina; Aygok, Gunes A.; Bullock, Ross.

In: Journal of Neurosurgery, Vol. 104, No. 5, 01.05.2006, p. 720-730.

Research output: Contribution to journalArticle

Marmarou, A, Signoretti, S, Fatouros, PP, Portella, G, Aygok, GA & Bullock, R 2006, 'Predominance of cellular edema in traumatic brain swelling in patients with severe head injuries', Journal of Neurosurgery, vol. 104, no. 5, pp. 720-730. https://doi.org/10.3171/jns.2006.104.5.720
Marmarou, Anthony ; Signoretti, Stefano ; Fatouros, Panos P. ; Portella, Gina ; Aygok, Gunes A. ; Bullock, Ross. / Predominance of cellular edema in traumatic brain swelling in patients with severe head injuries. In: Journal of Neurosurgery. 2006 ; Vol. 104, No. 5. pp. 720-730.
@article{60871ad83ee7426e957b8cd92180ad94,
title = "Predominance of cellular edema in traumatic brain swelling in patients with severe head injuries",
abstract = "Object. The edema associated with brain swelling after traumatic brain injury (TBI) has been thought to be vasogenic in origin, but the results of previous laboratory studies by the authors have shown that a cellular form of edema is mainly responsible for brain swelling after TBI. In this study the authors used magnetic resonance (MR) imaging techniques to identify the type of edema that occurs in patients with TBI. Methods. Diffusion-weighted MR imaging was used to evaluate the apparent diffusion coefficient (ADC) in 44 patients with TBI (Glasgow Coma Scale Score < 8) and in eight healthy volunteers. Higher ADC values have been associated with vasogenic edema, and lower ADC values with a predominantly cellular form of edema. Regional measurements of ADC in patients with focal and diffuse injury were computed. The water content of brain tissue was also assessed in absolute terms by using MR imaging to measure the percentage of water per gram of tissue. Cerebral blood flow (CBF) was measured using stable Xe-computerized tomography (CT) studies to rule out ischemia as a cause of cellular edema. The mean ADC value in the healthy volunteers was 0.82 ± 0.05 × 10-3 mm2/second. The ADC values in the patients with diffuse brain injury without swelling were close to the mean for the healthy volunteers. In contrast, the patients with brain swelling had increased brain water content and low ADC values (mean 0.74 ± 0.05 × 10-3 mm2/second). The ADC values correlated with CT classifications. In all patients with low ADC values, the CBF values were outside the range for ischemia. Conclusions. The brain swelling observed in patients with TBI appears to be predominantly cellular, as signaled by low ADC values in brain tissue with high levels of water content.",
keywords = "Apparent diffusion coefficient, Brain edema, Brain injury, Head injury, Trauma",
author = "Anthony Marmarou and Stefano Signoretti and Fatouros, {Panos P.} and Gina Portella and Aygok, {Gunes A.} and Ross Bullock",
year = "2006",
month = "5",
day = "1",
doi = "10.3171/jns.2006.104.5.720",
language = "English",
volume = "104",
pages = "720--730",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "5",

}

TY - JOUR

T1 - Predominance of cellular edema in traumatic brain swelling in patients with severe head injuries

AU - Marmarou, Anthony

AU - Signoretti, Stefano

AU - Fatouros, Panos P.

AU - Portella, Gina

AU - Aygok, Gunes A.

AU - Bullock, Ross

PY - 2006/5/1

Y1 - 2006/5/1

N2 - Object. The edema associated with brain swelling after traumatic brain injury (TBI) has been thought to be vasogenic in origin, but the results of previous laboratory studies by the authors have shown that a cellular form of edema is mainly responsible for brain swelling after TBI. In this study the authors used magnetic resonance (MR) imaging techniques to identify the type of edema that occurs in patients with TBI. Methods. Diffusion-weighted MR imaging was used to evaluate the apparent diffusion coefficient (ADC) in 44 patients with TBI (Glasgow Coma Scale Score < 8) and in eight healthy volunteers. Higher ADC values have been associated with vasogenic edema, and lower ADC values with a predominantly cellular form of edema. Regional measurements of ADC in patients with focal and diffuse injury were computed. The water content of brain tissue was also assessed in absolute terms by using MR imaging to measure the percentage of water per gram of tissue. Cerebral blood flow (CBF) was measured using stable Xe-computerized tomography (CT) studies to rule out ischemia as a cause of cellular edema. The mean ADC value in the healthy volunteers was 0.82 ± 0.05 × 10-3 mm2/second. The ADC values in the patients with diffuse brain injury without swelling were close to the mean for the healthy volunteers. In contrast, the patients with brain swelling had increased brain water content and low ADC values (mean 0.74 ± 0.05 × 10-3 mm2/second). The ADC values correlated with CT classifications. In all patients with low ADC values, the CBF values were outside the range for ischemia. Conclusions. The brain swelling observed in patients with TBI appears to be predominantly cellular, as signaled by low ADC values in brain tissue with high levels of water content.

AB - Object. The edema associated with brain swelling after traumatic brain injury (TBI) has been thought to be vasogenic in origin, but the results of previous laboratory studies by the authors have shown that a cellular form of edema is mainly responsible for brain swelling after TBI. In this study the authors used magnetic resonance (MR) imaging techniques to identify the type of edema that occurs in patients with TBI. Methods. Diffusion-weighted MR imaging was used to evaluate the apparent diffusion coefficient (ADC) in 44 patients with TBI (Glasgow Coma Scale Score < 8) and in eight healthy volunteers. Higher ADC values have been associated with vasogenic edema, and lower ADC values with a predominantly cellular form of edema. Regional measurements of ADC in patients with focal and diffuse injury were computed. The water content of brain tissue was also assessed in absolute terms by using MR imaging to measure the percentage of water per gram of tissue. Cerebral blood flow (CBF) was measured using stable Xe-computerized tomography (CT) studies to rule out ischemia as a cause of cellular edema. The mean ADC value in the healthy volunteers was 0.82 ± 0.05 × 10-3 mm2/second. The ADC values in the patients with diffuse brain injury without swelling were close to the mean for the healthy volunteers. In contrast, the patients with brain swelling had increased brain water content and low ADC values (mean 0.74 ± 0.05 × 10-3 mm2/second). The ADC values correlated with CT classifications. In all patients with low ADC values, the CBF values were outside the range for ischemia. Conclusions. The brain swelling observed in patients with TBI appears to be predominantly cellular, as signaled by low ADC values in brain tissue with high levels of water content.

KW - Apparent diffusion coefficient

KW - Brain edema

KW - Brain injury

KW - Head injury

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=33646470272&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33646470272&partnerID=8YFLogxK

U2 - 10.3171/jns.2006.104.5.720

DO - 10.3171/jns.2006.104.5.720

M3 - Article

VL - 104

SP - 720

EP - 730

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 5

ER -