Brainstem Diffuse Axonal Injury and Consciousness.
Ascending reticular activating system
Consciousness
Diffuse axonal injury
Magnetic resonance imaging
Traumatic brain injury
Journal
Journal of clinical imaging science
ISSN: 2156-7514
Titre abrégé: J Clin Imaging Sci
Pays: United States
ID NLM: 101564708
Informations de publication
Date de publication:
2019
2019
Historique:
received:
29
03
2019
accepted:
04
06
2019
entrez:
12
9
2019
pubmed:
12
9
2019
medline:
12
9
2019
Statut:
epublish
Résumé
Severe traumatic brain injuries (TBI), commonly due to motor vehicle accidents may cause death and long-term disability especially when the acceleration-deceleration force on the brain is massive. This may cause shearing of the axonal connections within the cerebral cortex and brainstem in a process referred to as diffuse axonal injury (DAI). Extensive DAI has been postulated to be a poor prognostic indicator for neurological recovery. In our institution, several patients with Grade 3 DAI were observed to recover and achieve neurological outcomes greater than expected given the presence of brainstem injury. MRI studies from 100 patients admitted to a large tertiary trauma center for TBI were retrospectively analyzed by two fellowship-trained neuroradiologists. The size of DAI lesions, location of injury within the brainstem, and the number of discrete DAI lesions were measured and recorded. Glasgow Coma Scale (GCS) on arrival and at discharge was noted, as well as the presence of other neurological injuries. Of 20 patients initially noted to have DAI with lesions of the brainstem, eight of them were discharged with Glasgow Coma Scale (GCS) of 14-15. The 12 patients discharged with reduced consciousness (average GC 7.1) demonstrated a greater number of larger lesions, with a predilection for the dorsal pons. These results suggest that large, numerous pontine lesions may indicate worse neurological outcomes in patients with these findings.
Sections du résumé
BACKGROUND
BACKGROUND
Severe traumatic brain injuries (TBI), commonly due to motor vehicle accidents may cause death and long-term disability especially when the acceleration-deceleration force on the brain is massive. This may cause shearing of the axonal connections within the cerebral cortex and brainstem in a process referred to as diffuse axonal injury (DAI). Extensive DAI has been postulated to be a poor prognostic indicator for neurological recovery. In our institution, several patients with Grade 3 DAI were observed to recover and achieve neurological outcomes greater than expected given the presence of brainstem injury.
METHODS
METHODS
MRI studies from 100 patients admitted to a large tertiary trauma center for TBI were retrospectively analyzed by two fellowship-trained neuroradiologists. The size of DAI lesions, location of injury within the brainstem, and the number of discrete DAI lesions were measured and recorded. Glasgow Coma Scale (GCS) on arrival and at discharge was noted, as well as the presence of other neurological injuries.
RESULTS
RESULTS
Of 20 patients initially noted to have DAI with lesions of the brainstem, eight of them were discharged with Glasgow Coma Scale (GCS) of 14-15. The 12 patients discharged with reduced consciousness (average GC 7.1) demonstrated a greater number of larger lesions, with a predilection for the dorsal pons.
CONCLUSION
CONCLUSIONS
These results suggest that large, numerous pontine lesions may indicate worse neurological outcomes in patients with these findings.
Identifiants
pubmed: 31508267
doi: 10.25259/JCIS-11-2019
pii: JCIS-9-32
pmc: PMC6712553
doi:
Types de publication
Journal Article
Langues
eng
Pagination
32Déclaration de conflit d'intérêts
There are no conflicts of interest.
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