Head Injury Clinical Trial
Official title:
Transcranial Doppler Measurement and Prognosis in Moderate Head Injury
The purpose of this study is to determine whether Transcranial Doppler measurements have correlation with neuropsychological test (Galvestone Orientation Amnesia Test), TC image (Marshall Scale) and prognosis (DRS and GOS) in moderate head injury
The head injury is a frequent problem of health, which produces high morbi-mortality. Today
is the main cause of death and disability between 18 and 40 years. In addition it originates
expensive expenses in health care systems.
Severity of cerebral injury is not only because of impact, it is implicated many
physiopathological changes. Decrease or increase of cerebral blood flow (CBF) play important
roll formation of edema and intracranial hypertension. Hypoxic/ischemic damage is the final
point of both changes.
The transcranial Doppler (TCD) was introduced around 1982. Through TCD can be measured the
flow velocity of intracranial arteries, which let us identify changes in diameter in
vessels. There are three windows of access to arteries: transtemporal, transorbitary and
suboccipital.
The parameter are systolic velocity (S), tele-diastolic velocity (D), mean velocity (M) and
pulsatility index (PI). Many studies have been conducted for evaluate utility in head
injury, TCD can identify changes that correlate with alteration in CBF intracranial pressure
(ICP).
The autoregulatory status is important, TCD with decrement in D and increment in PI could
tell us about failure in this issue. An invasive way for estimate cerebral perfusion
pressure (CCP) with TCD. The most sensible for fall in is amplitude in FV. However there is
more correlation between CPP and PI. Vasospasm can occur post trauma, for identify the
Lindegaard ratio (FVcma/FVcia) is useful. The other change, hyperemia, can be demonstrated
by continuously increase FV. In post traumatic time is very important identify alterations
which could produce ischemia. The measurement of CPP generally is gotten by invasión with
ICP determination.
In severe head injury has been demonstrated correlation between ICP and PI, strongest for
CPP and PI. Other parameters are oligaemia and vasospasm in the first 24 hours correlate
poor outcome.
Because of the non invasive characteristic and good correlation with physiologic and
prognosis, we think it is important evaluate if there are a kind of correlation between
amnesia and orientation, prognosis and TCD parameters.
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