Modelling midline shift and ventricle collapse in cerebral oedema following acute ischaemic stroke

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2024-05-28

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PLoS

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Article

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1553-734X

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Chen X, Józsa TI, Cardim D, et al., (2024) Modelling midline shift and ventricle collapse in cerebral oedema following acute ischaemic stroke. PLOS Computational Biology, Volume 20, Issue 5, May 2024, Article number e1012145

Abstract

In ischaemic stroke, a large reduction in blood supply can lead to the breakdown of the blood-brain barrier and to cerebral oedema after reperfusion therapy. The resulting fluid accumulation in the brain may contribute to a significant rise in intracranial pressure (ICP) and tissue deformation. Changes in the level of ICP are essential for clinical decision-making and therapeutic strategies. However, the measurement of ICP is constrained by clinical techniques and obtaining the exact values of the ICP has proven challenging. In this study, we propose the first computational model for the simulation of cerebral oedema following acute ischaemic stroke for the investigation of ICP and midline shift (MLS) relationship. The model consists of three components for the simulation of healthy blood flow, occluded blood flow and oedema, respectively. The healthy and occluded blood flow components are utilized to obtain oedema core geometry and then imported into the oedema model for the simulation of oedema growth. The simulation results of the model are compared with clinical data from 97 traumatic brain injury patients for the validation of major model parameters. Midline shift has been widely used for the diagnosis, clinical decision-making, and prognosis of oedema patients. Therefore, we focus on quantifying the relationship between ICP and midline shift (MLS) and identify the factors that can affect the ICP-MLS relationship. Three major factors are investigated, including the brain geometry, blood-brain barrier damage severity and the types of oedema (including rare types of oedema). Meanwhile, the two major types (stress and tension/compression) of mechanical brain damage are also presented and the differences in the stress, tension, and compression between the intraparenchymal and periventricular regions are discussed. This work helps to predict ICP precisely and therefore provides improved clinical guidance for the treatment of brain oedema.

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Attribution 4.0 International

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European Union’s Horizon 2020 research and innovation program (Grant No. 777072, INSIST project, INSIST – IN Silico clinical trials for Ischemic STroke to TIJ (insist-h2020.eu, between 2018 and 2022)).