Association of the bleeding time test with aspects of traumatic brain injury in patients with alcohol use disorder

Mathematical modelling of haemorrhagic transformation after ischaemic stroke

With an increasingly elderly population globally, the impacts of cerebrovascular diseases, such as stroke and dementia, become increasingly significant. Haemorrhagic transformation (HT) is one of the most common complications of ischaemic stroke that is caused by dysfunction of endothelial cells in the blood-brain barrier (BBB) and that can be exacerbated by thrombolytic therapy. Recent studies also suggest that HT can lead to an increase in intracranial pressure (ICP) and result in capillary compression. The aim of this study is to develop a mathematical model that can be used to simulate the consequence of HT over a range of vasculature length scales. We use a 2D vasculature model to investigate the severity of HT with different vascular geometry. The resulting model shows that the haematoma radius is approximately constant across different length scales (100-1000μm) and in good agreement with the available experimental data. In addition, this study identified that the effects of capillary compression do appear to have a significant impact on the leakage fraction of blood and hence act to restrain the development of a haematoma.

Pre-injury chronic alcohol abuse predicts intracranial hemorrhagic progression, unfavorable clinical outcome, and mortality in severe traumatic brain injury

OBJECTIVE

We aimed to determine the incidence of pre-injury alcohol abuse in TBI at our neurointensive care unit (NICU), the relation to intracranial hemorrhage evolution, and clinical outcome.

METHODS

Patients with TBI treated at our NICU at Uppsala university hospital, Sweden, 2008-2018, were included. Clinical, radiological, and outcome variables were evaluated.

RESULTS

Of 844 patients with TBI, 147 (17%) had a history of pre-injury alcohol abuse and these patients were slightly older, but had a similar Charlson co-morbidity index as the other patients. They were more often injured by falls and more frequently developed acute subdural hematomas and cerebral contusions. Their platelets were lower and their IVY bleeding time slightly longer. Patients with pre-injury alcohol abuse more often exhibited an intracranial hemorrhage progression on the second computed tomography. Pre-injury alcohol abuse was an independent predictor of increased mortality (odds ratio = 2.96, p-value = 0.001) and decreased favorable outcome (odds ratio = 0.46, p-value = 0.001) in multiple regression analyses.

CONCLUSIONS

Pre-injury alcohol abuse was common in severe TBI, associated with coagulopathy, worse intracranial hemorrhage/injury evolution, and independently predicted poor clinical outcome. These patients deserve more attention in care and research to address specific challenges including disturbed hemostasis.