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Jurg L. Jaggi, Walter D. Obrist, Thomas A. Gennarelli, and Thomas W. Langfitt

injury and CMRO 2 measurement (F = 0.50, p < 0.68). Fig. 1. Acute cerebral metabolic rate for oxygen (CMRO 2 , mean ± standard deviation) plotted against the Glasgow Outcome Scale score at 6 months postinjury. PVS = persistent vegetative state; SD = severe disability; MD = moderate disability; GR = good recovery. Cerebral metabolism was significantly higher in patients with better outcomes (F = 4.34, p < 0.008). A similar analysis of variance for CBF and outcome, presented in Fig. 2 , demonstrated no significant relationship (F = 0.76, p < 0.52). It

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Walter D. Obrist, Thomas W. Langfitt, Jurg L. Jaggi, Julio Cruz, and Thomas A. Gennarelli

blood flow (CBF) (p < 0.02, chi-square test). Arteriovenous Oxygen Differences The difference between arterial and jugular venous O 2 content provides a means of assessing the overall balance between cerebral metabolism and blood flow, thereby indicating the presence of global ischemia or hyperemia. This is evident from rearrangement of the Fick equation: AVDO 2 = CMRO 2 /CBF. 27 Thus, when CBF is low relative to the brain's metabolic needs (ischemia), a wide AVDO 2 is obtained. Conversely, when CBF is high relative to metabolism (hyperemia), a

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Walter D. Obrist, Thomas A. Gennarelli, Hiromu Segawa, Carol A. Dolinskas, and Thomas W. Langfitt

). This difference was significant at the 0.01 level of confidence (Mann-Whitney U test). Evidence of Luxury Perfusion Because of earlier reports that cerebral metabolism is depressed in coma, 1, 3, 28 the present finding of hyperemia in certain comatose patients raises a question concerning the relationship between CBF and metabolism in this condition. Specifically, is the elevated blood flow coupled with a high cerebral metabolic rate, or is there a dissociation between blood flow and metabolism, such that CBF is in excess of metabolic demand? An attempt

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Julio Cruz, Michael E. Miner, Steven J. Allen, Wayne M. Alves, and Thomas A. Gennarelli

its regulation after closed head injury with emphasis on clinical correlations. J Neurosurg 41 : 531 – 541 , 1974 Overgaard J, Tweed WA: Cerebral circulation after head injury. Part 1: Cerebral blood flow and its regulation after closed head injury with emphasis on clinical correlations. J Neurosurg 41: 531–541, 1974 17. Rappaport ZH , Ransohoff J , Hass WK : Cerebral metabolism in head trauma. Prog Neurol Surg 10 : 1 – 13 , 1981 Rappaport ZH, Ransohoff J, Hass WK: Cerebral metabolism in head trauma