Wartime traumatic cerebral vasospasm: Recent review of combat casualties

Objective: Blast related neurotrauma is associated with the severest casualties from Operation Iraq Freedom (OIF). A consequences of this is cerebral vasospasm. This study evaluated all inpatient neurosurgical consults related to battle injury from OIF. Methods: Evaluation of all admissions from OIF from April 2003 to October 2005 was performed on patients with neurotrauma and a diagnostic cerebral angiogram. Differences between patients with and without vasospasm and predictors of vasospam were analyzed. Results: Fifty-seven out of 119 nuerosurgical consults were evaluated. Of these, 47.4% had traumatic vasospasm sustained blast trauma. Average spasm duration was 14.3 days, with a range of up to 30 days vasospasm was associated with the presence of pseudoaneurysm (P = 0.05), hemorrhage (P = 0.03), the number of lobes injured (P = 0.012), and mortality (P = 0.029). Those with vasospasm fared worse than those without (p = 0.002). The number of lobes injured and the presence of pseudoaneurysm were significant predictors of vasospasm (P = 0.016 and 0.02, respectively). There was a significant quadratic trend towards nuerological improvement for those recieving aggressive open surgical treatment (P = 0.002). In the vasospam group, angioplasty with microballoon significantly lowered middle cerebrel artery and basilar blood-flow velocities (P = 0.046 and 0.026, respectively). Conclusion: Traumatic vasospasm occurred in a sustantial number of patients with severe neurotrauma, and clinical outcomes were worse for those with this condition. However, aggressive open surgical and endovascular treatment strategies may have improved outcome. This was the first study to analyze the effects of blast-related injury on the cerebral vasculature.