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Increased intracranial pressure in severe traumatic axonal injury patients - A retrospective single-center study

Westerberg, Gustaf LU ; Hossain, Iftakher ; Drake, Mattias LU ; Tsitsopoulos, Parmenion P. and Marklund, Niklas LU orcid (2026) In Brain and Spine 6.
Abstract

Introduction: Traumatic axonal injury (TAI), often caused by rapid rotational forces and high-energy accidents, is common in severe traumatic brain injury (sTBI). The intracranial pressure (ICP) dynamics are often unpredictable, and the need for ICP monitoring remains debated. Research question: What is the incidence of ICP elevation in patients with TAI, and how often is escalated ICP-lowering treatment required? Material and methods: Retrospectively, sTBI patients treated between 2007 and 2022 with TAI lesions at the grey–white matter interface, corpus callosum, deep central structures, and/or brainstem, on magnetic resonance imaging (MRI) were included. Patients with ICP elevation despite baseline management were treated according to... (More)

Introduction: Traumatic axonal injury (TAI), often caused by rapid rotational forces and high-energy accidents, is common in severe traumatic brain injury (sTBI). The intracranial pressure (ICP) dynamics are often unpredictable, and the need for ICP monitoring remains debated. Research question: What is the incidence of ICP elevation in patients with TAI, and how often is escalated ICP-lowering treatment required? Material and methods: Retrospectively, sTBI patients treated between 2007 and 2022 with TAI lesions at the grey–white matter interface, corpus callosum, deep central structures, and/or brainstem, on magnetic resonance imaging (MRI) were included. Patients with ICP elevation despite baseline management were treated according to the Lund Concept, including beta-blockers, clonidine, and albumin. Decompressive craniectomy (DC) or high-dose barbiturate infusion was reserved for refractory ICP elevation. Results: Thirty-one TAI patients (15 women and 16 men) presented with a median Glasgow Coma Scale motor score of 2 (range 1–6). All patients had TAI lesion in the grey-white interface, 27 patients also in the corpus callosum, and 16 patients had brainstem lesions. Elevated ICP was observed in 16 patients (52 %), of whom 4/16 (25 %) received either DC (n = 2), high-dose barbiturates (n = 1) or both (n = 1). Discussion and conclusion: The risk of increased ICP in TAI patients has been debated. Our present results, showing that 52 % of TAI patients experienced elevated ICP requiring escalated ICP-lowering strategies, argue that ICP monitoring is required in TAI. The impact of increased ICP on outcome following TAI should be explored in future studies.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Intracranial hypertension, Intracranial pressure, Neurocritical care, Outcome, Traumatic axonal injury, Traumatic brain injury
in
Brain and Spine
volume
6
article number
105945
publisher
Elsevier
external identifiers
  • pmid:41737875
  • scopus:105030287388
ISSN
2772-5294
DOI
10.1016/j.bas.2026.105945
language
English
LU publication?
yes
id
98cc7824-d90f-446e-815b-efa402477c06
date added to LUP
2026-03-02 11:48:37
date last changed
2026-07-08 09:28:39
@article{98cc7824-d90f-446e-815b-efa402477c06,
  abstract     = {{<p>Introduction: Traumatic axonal injury (TAI), often caused by rapid rotational forces and high-energy accidents, is common in severe traumatic brain injury (sTBI). The intracranial pressure (ICP) dynamics are often unpredictable, and the need for ICP monitoring remains debated. Research question: What is the incidence of ICP elevation in patients with TAI, and how often is escalated ICP-lowering treatment required? Material and methods: Retrospectively, sTBI patients treated between 2007 and 2022 with TAI lesions at the grey–white matter interface, corpus callosum, deep central structures, and/or brainstem, on magnetic resonance imaging (MRI) were included. Patients with ICP elevation despite baseline management were treated according to the Lund Concept, including beta-blockers, clonidine, and albumin. Decompressive craniectomy (DC) or high-dose barbiturate infusion was reserved for refractory ICP elevation. Results: Thirty-one TAI patients (15 women and 16 men) presented with a median Glasgow Coma Scale motor score of 2 (range 1–6). All patients had TAI lesion in the grey-white interface, 27 patients also in the corpus callosum, and 16 patients had brainstem lesions. Elevated ICP was observed in 16 patients (52 %), of whom 4/16 (25 %) received either DC (n = 2), high-dose barbiturates (n = 1) or both (n = 1). Discussion and conclusion: The risk of increased ICP in TAI patients has been debated. Our present results, showing that 52 % of TAI patients experienced elevated ICP requiring escalated ICP-lowering strategies, argue that ICP monitoring is required in TAI. The impact of increased ICP on outcome following TAI should be explored in future studies.</p>}},
  author       = {{Westerberg, Gustaf and Hossain, Iftakher and Drake, Mattias and Tsitsopoulos, Parmenion P. and Marklund, Niklas}},
  issn         = {{2772-5294}},
  keywords     = {{Intracranial hypertension; Intracranial pressure; Neurocritical care; Outcome; Traumatic axonal injury; Traumatic brain injury}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Brain and Spine}},
  title        = {{Increased intracranial pressure in severe traumatic axonal injury patients - A retrospective single-center study}},
  url          = {{http://dx.doi.org/10.1016/j.bas.2026.105945}},
  doi          = {{10.1016/j.bas.2026.105945}},
  volume       = {{6}},
  year         = {{2026}},
}