-Review-

Cerebral Endothelial Damage after Severe Head Injury

Hiroyuki Yokota

Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Nippon Medical School

We demonstrate that in head injuries the degree of cerebral endothelial activation or injury depends on the type of brain injury and the patient's age, and that in severe head injuries measuring the serum levels of thrombomodulin (TM) and von Willebrand factor (vWF) is useful in evaluating cerebral endothelial injury and activation. The values of vWF in the cases of focal brain injury were significantly higher than in the cases of diffuse axonal injury. The serum levels of TM in focal brain injuries were higher than in diffuse axonal injuries, but the differences were not statistically significant. In patients with delayed traumatic intracerebral hematoma (DTICH), vWF levels were much higher than in patients without DTICH. The values of TM and vWF in elderly patients were significantly higher than in younger patients. These findings indicate that: 1) the degree of endothelial activation in focal brain injury is significantly higher than in diffuse brain injury; 2) the degree of cerebral endothelial injury in patients with DTICH is much higher than in those without DTICH; and 3) the degree of cerebral endothelial activation and injury in elderly head injury patients is significantly higher than in younger patients.

J Nippon Med Sch 2007; 74: 332-337

Keywords
cerebral endothelial injury, head injury, thrombomodulin, von Willebrand factor, delayed traumatic intracerebral hematoma, elderly patients

Correspondence to
Hiroyuki Yokota, MD, Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
yokota@nms.ac.jp

Received, June 13, 2007
Accepted, August 3, 2007