Hemodynamic Stroke Caused by Severe Traumatic Hemorrhagic Shock; Clinical Features of 4 Cases

Hemodynamic stroke (HS) is defined as cerebral infarction caused by cerebral hypoperfusion with systemic hypotension involving perioperative complications of cardiovascular surgery, cardiogenic shock, and severe carotid stenosis or occlusion. HS theoretically should occur in trauma patients with severe hemorrhagic shock, but clinical reports of HS are rare. We report 4 patients with HS following severe hemorrhagic shock due to trauma in the absence of head or neck injury. These cases suggest that cerebral damage resulted from a generalized reduction in cerebral blood flow secondary to hemorrhagic shock caused by trauma, which required massive blood transfusion. Computed tomography (CT) should that 3 patients had cerebral arterial boundary zone infarction and 1 had an infarction in the territories of the bilateral posterior cerebral artery (PCA). Magnetic resonance (MR) angiography conducted in 3 patients confirmed that none had detectable stenosis or occlusion of the bilateral internal carotid arteries (ICA), vertebrobasilar arteries, or large intracranial arteries. The cerebral arterial boundary zone and territory of PCA are known to be vulnerable to profound hemodynamic disturbance because of insufficient collateral supply. These findings suggest that severe posttraumatic hemorrhagic shock, in the absence of ICA stenosis or large intracranial arterial stenosis, is likely to produce HS. These cases highlight the critical importance of systemic resuscitation in all cases of trauma to prevent secondary brain damage.