Critical Care and Shock

Posttraumatic cerebral infarction caused by hemodynamic shearing stress following hemorrhagic shock


Background: Posttraumatic cerebral infarction (PTCI) is very rare and its pathogenesis is not well defined. In the case presented here, hemorrhagic shock was strongly suspected to be associated with the development of PTCI. Therefore, we hypothesized that a powerful shearing stress affected the pathogenesis of vulnerable endothelium causing damage and resulting in PTCI. By elucidating these mechanisms, it may be possible to predict the occurrence of PTCI.

Case: An 80-year-old woman was transferred to the emergency room after a traffic accident where her car collided against a wall. Upon admission, it was confirmed that she had a low Glasgow Coma Score (GCS); however, neither hemorrhage nor infarction appeared on initial brain computed tomography (CT) scans. Additionally, she had hemorrhagic shock (blood pressure 88/52 mmHg) causing hemothorax with multiple rib fractures, as well as fractures in the left humerus and thighbone. The patient did not seem to be able to move the left half of her body because of pain, and still had a low GCS 12 h after admission. Hence, diffusion-weighted magnetic resonance imaging (MRI) was performed and revealed acute cerebral infarction in the right temporal lobe, and MR angiography demonstrated moderate stenosis of the horizontal portion of the right middle cerebral artery.

Conclusions: To our knowledge, sudden hypotension following hemorrhagic shock produced a strong shear stress, which induced platelet aggregation and lead to the development of a cerebral infarction in our case.