Tawil et al identified risk factors associated with posttraumatic cerebral infarction (PTCI) in a patient after traumatic brain injury (TBI). These can help identify a patient who may benefit from closer monitoring and more aggressive management. The authors are from the University of New Mexico in Albuquerque.


Patient selection: traumatic brain injury


Mechanisms of the cerebral infarction may include:

(1) cerebral swelling

(2) tonsillar herniation

(3) vasospasm

(4) thromboembolism


Diagnostic features of PTCI on nonenhanced head CT: well-demarcated region of low attenuation conforming to an arterial vascular distribution.


Diagnostic features of PTCI on head MRI:

(1) The presence of a well-demarcated region of low signal on T1-weighted images OR high signal on T2-weighted images OR fluid attenuation inversion recovery sequences.

(2) The region has an arterial vascular distribution.

(3) There is a high signal on diffusion weighted images associated with a corresponding decrease in signal on the apparent diffusion coefficient map.


Risk factors for secondary cerebral infarction:

(1) therapy with recombinant Factor VIIa

(2) post-craniotomy

(3) blunt cerebral vascular injury (BCVI)

(4) brain AIS 3 or more


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