Hyper flow and intracranial hypertension in diffuse axonal injury: an update to gennarelli doctrine.

Twelve consecutive paediatric (six) and adult (six) patients harbouring a neuroradiological pattern consistent with diffuse axonal injury (DAI) along with slit ventricles underwent haemodynamic study in the Intensive Care Unit of our University. All the patients had GCS scores less than 8 after a severe brain injury. serial head computed tomography (CT) and magnetic resonance (MR) scans demonstrated a radiological pattern of DAI. Transcranial Doppler Sonography (TCD) of the middle cerebral arteries was performed through the temporal bone window in all the patients. All patients but one underwent a continuous monitoring of intracranial pressure (ICP) and cerebral extraction of 02 (CEO2). Therapy with barbiturates and hyperventilation was necessary in all the cases. In two patients (one adult and one paediatric) a bilateral decompressive craniectomy was performed in order to decrease a severe intracranial hypertension. Hyperflow along with intracranial hypertension, variably responsive to barbiturate therapy, was observed in all the patients by means of TCD and CEO2. In our patients intracranial hypertension along with hyperflow syndrome were found associated with DAI. Medical as well as surgical treatments were tailored according to the haemodynamic study.