• Alexander Razumovsky, Teodoro Tigno, Sven M Hochheimer, Fred L Stephens, Randy Bell, Alexander H Vo, Meryl A Severson, Scott A Marshall, Stephen M Oppenheimer, Robert Ecker, and Rocco A Armonda.
• Sentient NeuroCare Services, Inc, Hunt Valley, MD, USA. arazumovsky@sentientmedical.com
• Acta Neurochir. Suppl. 2013 Jan 1; 115: 87-90.

AbstractTraumatic brain injury (TBI) is associated with the severest casualties from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). From October 1, 2008, the U.S. Army Medical Department initiated a transcranial Doppler (TCD) ultrasound service for TBI; included patients were retrospectively evaluated for TCD-determined incidence of post-traumatic cerebral vasospasm and intracranial hypertension after wartime TBI. Ninety patients were investigated with daily TCD studies and a comprehensive TCD protocol, and published diagnostic criteria for vasospasm and increased intracranial pressure (ICP) were applied. TCD signs of mild, moderate, and severe vasospasms were observed in 37%, 22%, and 12% of patients, respectively. TCD signs of intracranial hypertension were recorded in 62.2%; 5 patients (4.5%) underwent transluminal angioplasty for post-traumatic clinical vasospasm treatment, and 16 (14.4%) had cranioplasty. These findings demonstrate that cerebral arterial spasm and intracranial hypertension are frequent and significant complications of combat TBI; therefore, daily TCD monitoring is recommended for their recognition and subsequent management.

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